MEDICARE: PEACE WITHIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003385386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACE WITHIN

Provider Business Mailing Address
First Line	:	5904 S. COOPER STE. 104 - PMB 162
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017
Country	:	US
Telephone Number	:	682-331-2685
Fax Number	:	682-204-6648

Provider Business Practice Location Address
First Line	:	5904 S. COOPER STE. 104 - PMB 162
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017
Country	:	US
Telephone Number	:	682-331-2685
Fax Number	:	682-204-6648

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR
Name	:	SHARON J DURHAM
Credential	:	MS, LPC
Telephone Number	:	682-331-2685

Provider Enumeration Date	:	11/16/2018
Last Update Date	:	11/16/2018

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Directions to “PEACE WITHIN ” Practice Location

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