MEDICARE: PEACE AND WELLNESS THERAPY SERVICES 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	:	1689369589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACE AND WELLNESS THERAPY SERVICES LLC

Provider Business Mailing Address
First Line	:	49 SHORT HILLS CIR
Second Line	:
City	:	MILLBURN
State	:	NJ
Zip	:	07041-1233
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	49 SHORT HILLS CIR
Second Line	:
City	:	MILLBURN
State	:	NJ
Zip	:	07041-1233
Country	:	US
Telephone Number	:	973-896-0449
Fax Number	:

Authorized Official
Title or Position	:	PART OWNER
Name	:	LESLEY MCDONALD
Credential	:
Telephone Number	:	973-896-0449

Provider Enumeration Date	:	04/06/2023
Last Update Date	:	04/06/2023

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