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General NPI Number Information
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NPI Number | 1952963076
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Entity Type | Organization
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Legal Business Name | PEACEFUL MIND MENTAL HEALTH, LLC
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Dates
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Enumeration Date | 06/29/2019
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Last Update Date | 04/11/2022
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Provider Practice Location Address
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Address Line | 118 MAIN AVE N STE 203
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City | NEW YORK MILLS
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State | MN
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Zip | 56567-4405
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Country | US
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Telephone | 218-731-8896
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Fax | 855-852-5355
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Provider Business Mailing Address
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Address Line | PO BOX 341
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City | NEW YORK MILLS
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State | MN
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Zip | 56567-0341
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Country | US
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Telephone | 218-731-8896
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Fax | 855-852-5355
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Authorized Official
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Title or Position | THERAPIST
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Name | REBECCA KOSKINIEMI
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Credential | LICSW
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Telephone | 218-731-8896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) 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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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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 |
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