=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780319046
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEACE OF MIND WELLNESS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2022
-----------------------------------------------------
Last Update Date | 12/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 78 MIDDLE ST STE 1
-----------------------------------------------------
City | FAIRHAVEN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02719-3050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-320-4141
-----------------------------------------------------
Fax | 888-334-5830
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 78 MIDDLE ST STE 1
-----------------------------------------------------
City | FAIRHAVEN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02719-3050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-320-4141
-----------------------------------------------------
Fax | 888-334-5830
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PMHNP
-----------------------------------------------------
Name | KATIE ANN BROWN
-----------------------------------------------------
Credential | PMHNP
-----------------------------------------------------
Telephone | 774-320-4141
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------