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General NPI Number Information
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NPI Number | 1699211193
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Entity Type | Organization
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Legal Business Name | PEACEFUL MINDS RECOVERY SERVICES
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Dates
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Enumeration Date | 01/09/2017
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Last Update Date | 01/09/2017
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Provider Practice Location Address
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Address Line | 1731 S HIGHWAY 160
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City | PAHRUMP
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State | NV
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Zip | 89048-4711
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Country | US
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Telephone | 775-209-9213
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3305
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City | PAHRUMP
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State | NV
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Zip | 89041-3305
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/ THERAPIST
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Name | MS. DIANA CHACON
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Credential | CPCI
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Telephone | 775-209-9213
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | NV20161003250
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License Number State | NV
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