MEDICARE: PEACE THERAPY

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	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

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	:	1366915944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACE THERAPY

Provider Business Mailing Address
First Line	:	10461 6 MILE CYPRESS PKWY STE 504
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-6513
Country	:	US
Telephone Number	:	941-467-2980
Fax Number	:

Provider Business Practice Location Address
First Line	:	10461 6 MILE CYPRESS PKWY STE 504
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-6513
Country	:	US
Telephone Number	:	941-467-2980
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JEFFREY DOUGLAS LAPHAM
Credential	:	LMHC
Telephone Number	:	941-467-2980

Provider Enumeration Date	:	01/07/2019
Last Update Date	:	09/11/2024

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Directions to “PEACE THERAPY ” Practice Location

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