MEDICARE: PEACEFUL COUNSELING LLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1124842851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACEFUL COUNSELING LLC

Provider Business Mailing Address
First Line	:	1710 KELLER PKWY # 4411
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-3749
Country	:	US
Telephone Number	:	216-744-2061
Fax Number	:	440-984-2097

Provider Business Practice Location Address
First Line	:	3848 W 130TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-3316
Country	:	US
Telephone Number	:	216-744-2061
Fax Number	:	440-984-2097

Authorized Official
Title or Position	:	COUNSELOR TRAINEE
Name	:	MS. ELYSE ROBINSON
Credential	:
Telephone Number	:	216-744-2061

Provider Enumeration Date	:	11/11/2024
Last Update Date	:	11/11/2024

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