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General NPI Number Information
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NPI Number | 1740524990
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Entity Type | Organization
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Legal Business Name | A PEACE OF MIND THERAPY LLC
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Dates
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Enumeration Date | 11/11/2012
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Last Update Date | 11/11/2012
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Provider Practice Location Address
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Address Line | 2319 S HIGHWAY 77 UNIT 457
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City | LYNN HAVEN
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State | FL
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Zip | 32444-7720
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Country | US
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Telephone | 850-624-2346
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Fax |
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Provider Business Mailing Address
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Address Line | 2319 S HIGHWAY 77 UNIT 457
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City | LYNN HAVEN
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State | FL
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Zip | 32444-7720
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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 | LICENSED MENTAL HEALTH COUNSELOR
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Name | MR. DALE R HEPPE
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Credential | M.S., LMHC
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Telephone | 850-624-2346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH10915
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License Number State | FL
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