MEDICARE: PEACE & CALM 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1134740046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACE & CALM COUNSELING LLC.

Provider Business Mailing Address
First Line	:	8703 N FITZGERALD WAY
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-6737
Country	:	US
Telephone Number	:	734-788-0557
Fax Number	:

Provider Business Practice Location Address
First Line	:	8703 N FITZGERALD WAY
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-6737
Country	:	US
Telephone Number	:	734-788-0557
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ERIC DARNELL MCCLURE
Credential	:	LCSW
Telephone Number	:	734-788-0557

Provider Enumeration Date	:	05/01/2020
Last Update Date	:	05/01/2020

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