Provider Demographics
NPI:1366080004
Name:PEACE OF MIND THERAPY SERVICES PLLC
Entity type:Organization
Organization Name:PEACE OF MIND THERAPY SERVICES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AUTUMN
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:810-226-9202
Mailing Address - Street 1:8387 E COLDWATER RD
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-8966
Mailing Address - Country:US
Mailing Address - Phone:810-226-9202
Mailing Address - Fax:
Practice Address - Street 1:8308 OFFICE PARK DR STE 2
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2075
Practice Address - Country:US
Practice Address - Phone:810-226-9202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-12
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty