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General NPI Number Information
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NPI Number | 1992458459
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Entity Type | Organization
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Legal Business Name | PEACEFUL MINDS CLINICAL SERVICE
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Dates
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Enumeration Date | 02/03/2022
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Last Update Date | 02/03/2022
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Provider Practice Location Address
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Address Line | 3202 AUTUMN RIDGE CT APT 6
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-7468
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Country | US
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Telephone | 502-895-1611
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Fax |
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Provider Business Mailing Address
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Address Line | 4010 DUPONT CIR STE 565
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City | LOUISVILLE
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State | KY
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Zip | 40207-4888
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Country | US
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Telephone | 502-895-1611
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Fax | 502-895-1633
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MONICA GRAVES
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Credential | APRN
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Telephone | 502-895-1611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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