Provider Demographics
NPI:1194104695
Name:PEACE OF MIND FAMILY GUIDANCE AND COUNSELING, PLLC
Entity type:Organization
Organization Name:PEACE OF MIND FAMILY GUIDANCE AND COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:R
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:210-380-6301
Mailing Address - Street 1:5626 CROSS POND
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3825
Mailing Address - Country:US
Mailing Address - Phone:210-380-6301
Mailing Address - Fax:210-362-1824
Practice Address - Street 1:5626 CROSS POND
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-3825
Practice Address - Country:US
Practice Address - Phone:210-380-6301
Practice Address - Fax:210-362-1824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61232101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty