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NPI Code Detail

MEDICARE: A PEACE OF MIND WELLNESS LLC

MEDICARE: A PEACE OF MIND WELLNESS 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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1750966982
Entity Type Code : Organization
Provider Name (Legal Business Name) : A PEACE OF MIND WELLNESS LLC
Provider Business Mailing Address
First Line : 5734 DOUGLAS RD
Second Line :
City : TOLEDO
State : OH
Zip : 43613-2038
Country : US
Telephone Number : 419-724-1500
Fax Number : 419-724-1616
Provider Business Practice Location Address
First Line : 5734 DOUGLAS RD
Second Line :
City : TOLEDO
State : OH
Zip : 43613-2038
Country : US
Telephone Number : 419-724-1500
Fax Number : 419-724-1616
Authorized Official
Title or Position : CCO
Name : JENNIFER FACKELMAN
Credential : LISW-S, LICDC-CS
Telephone Number : 419-724-1500
Provider Enumeration Date : 03/09/2021
Last Update Date : 11/15/2022

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Directions to “A PEACE OF MIND WELLNESS LLC ” Practice Location

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