Provider Demographics
NPI: | 1124874169 |
---|---|
Name: | PEACE OF MIND MENTAL HEALTH AND BEHAVIOR SERVICES, LLC |
Entity type: | Organization |
Organization Name: | PEACE OF MIND MENTAL HEALTH AND BEHAVIOR SERVICES, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | BRYNN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BELL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LCSW, BCBA, LBA |
Authorized Official - Phone: | 435-862-1625 |
Mailing Address - Street 1: | 230 N 1680 E BLDG F |
Mailing Address - Street 2: | |
Mailing Address - City: | ST GEORGE |
Mailing Address - State: | UT |
Mailing Address - Zip Code: | 84790-2579 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 435-417-0073 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 230 N 1680 E BLDG F |
Practice Address - Street 2: | |
Practice Address - City: | ST GEORGE |
Practice Address - State: | UT |
Practice Address - Zip Code: | 84790-2579 |
Practice Address - Country: | US |
Practice Address - Phone: | 435-417-0073 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2024-04-29 |
Last Update Date: | 2024-05-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Single Specialty |