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General NPI Number Information
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NPI Number | 1841792751
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Entity Type | Organization
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Legal Business Name | PEACEFUL MIND THERAPY, LLC
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Dates
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Enumeration Date | 03/06/2018
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Last Update Date | 12/02/2023
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Provider Practice Location Address
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Address Line | 2509 TANBARK CT
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City | LAS VEGAS
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State | NV
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Zip | 89108-3876
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Country | US
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Telephone | 702-254-6703
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Fax |
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Provider Business Mailing Address
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Address Line | 4169 CRAIGEND LOOP
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City | GULF SHORES
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State | AL
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Zip | 36542-5822
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Country | US
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Telephone | 702-325-4670
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | ODELIA DUHEL
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Credential |
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Telephone | 702-325-4670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State | NV
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