Provider Demographics
NPI:1114567690
Name:PEACE OF MIND COUNSELING SERVICE
Entity type:Organization
Organization Name:PEACE OF MIND COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:UNDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-542-6854
Mailing Address - Street 1:6019 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-0415
Mailing Address - Country:US
Mailing Address - Phone:928-542-6854
Mailing Address - Fax:
Practice Address - Street 1:1 PLAZA SQ STE 100
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-5513
Practice Address - Country:US
Practice Address - Phone:928-542-6854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health