MEDICARE: A PEACEFUL MIND BEHAVIOR SERVICES

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	103TB0200X	Cognitive & Behavioral Psychologist

General Provider Information

NPI Number	:	1467299453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A PEACEFUL MIND BEHAVIOR SERVICES

Provider Business Mailing Address
First Line	:	12381 S CLEVELAND AVE STE 403
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3853
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12381 S CLEVELAND AVE STE 403
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3853
Country	:	US
Telephone Number	:	239-266-2620
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS MANAGER/POINT OF CONTACT
Name	:	DR. MICHELE RENZULLI
Credential	:	PHD
Telephone Number	:	239-533-9604

Provider Enumeration Date	:	07/09/2024
Last Update Date	:	07/09/2024

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