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General NPI Number Information
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NPI Number | 1740710714
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Entity Type | Organization
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Legal Business Name | PEACE OF MIND JAX
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Dates
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Enumeration Date | 06/13/2017
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 7875 NW 12TH ST STE 118
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City | DORAL
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State | FL
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Zip | 33126-1815
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Country | US
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Telephone | 786-505-4449
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Fax | 786-667-3733
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Provider Business Mailing Address
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Address Line | 7875 NW 12TH ST STE 118
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City | DORAL
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State | FL
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Zip | 33126-1815
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Country | US
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Telephone | 786-505-4449
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Fax | 786-667-3733
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. MICHELLE CASTANOS
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Credential | M.ED., BCBA
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Telephone | 786-853-1742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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