1952963076 NPI number — PEACEFUL MIND MENTAL HEALTH, LLC

Table of content: (NPI 1952963076)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952963076 NPI number — PEACEFUL MIND MENTAL HEALTH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEACEFUL MIND MENTAL HEALTH, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952963076
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 341
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK MILLS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56567-0341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-731-8896
Provider Business Mailing Address Fax Number:
855-852-5355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
118 MAIN AVE N STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK MILLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56567-4405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-731-8896
Provider Business Practice Location Address Fax Number:
855-852-5355
Provider Enumeration Date:
06/29/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KOSKINIEMI
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
Authorized Official Title or Position:
THERAPIST
Authorized Official Telephone Number:
218-731-8896

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)