MEDICARE: PEACE & PURPOSE EMDR COUNSELING 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1952098949
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACE & PURPOSE EMDR COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	400 N WASHINGTON ST STE 102
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-1702
Country	:	US
Telephone Number	:	573-535-9398
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 N WASHINGTON ST STE 102
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-1702
Country	:	US
Telephone Number	:	573-535-9398
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HEIDI MARIE ALLEN
Credential	:	LCSW
Telephone Number	:	573-535-9398

Provider Enumeration Date	:	04/19/2023
Last Update Date	:	04/19/2023

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