Provider Demographics
NPI:1366915944
Name:PEACE THERAPY
Entity type:Organization
Organization Name:PEACE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:LAPHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:941-467-2980
Mailing Address - Street 1:10461 6 MILE CYPRESS PKWY STE 504
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-6513
Mailing Address - Country:US
Mailing Address - Phone:941-467-2980
Mailing Address - Fax:
Practice Address - Street 1:10461 6 MILE CYPRESS PKWY STE 504
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-6513
Practice Address - Country:US
Practice Address - Phone:941-467-2980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-07
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116077800Medicaid