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General NPI Number Information
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NPI Number | 1801483060
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Entity Type | Organization
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Legal Business Name | PEACEFUL PASTURES THERAPY LLC
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Dates
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Enumeration Date | 12/22/2020
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 36178 GRESHAM RD
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City | WEBSTER
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State | FL
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Zip | 33597-9287
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Country | US
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Telephone | 813-449-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 36156 GRESHAM RD
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City | WEBSTER
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State | FL
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Zip | 33597-9287
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Country | US
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Telephone | 813-449-2500
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA OLIVER
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Credential | MSW, RCSWI
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Telephone | 813-449-2500
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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