1265796072 NPI number — PEACE OF MIND THERAPY SERVICES

Table of content: ALEXANDRA DEIANA CPD, LE (NPI 1003684184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265796072 NPI number — PEACE OF MIND THERAPY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEACE OF MIND THERAPY SERVICES
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:
1265796072
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 BOONE ST
Provider Second Line Business Mailing Address:
SUITE 27
Provider Business Mailing Address City Name:
JOHNSON CITY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37604-5603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-444-3677
Provider Business Mailing Address Fax Number:
423-244-0602

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 BOONE ST
Provider Second Line Business Practice Location Address:
SUITE 27
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-5603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-444-3677
Provider Business Practice Location Address Fax Number:
423-244-0602
Provider Enumeration Date:
06/26/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HARTSELL
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
THERAPIST
Authorized Official Telephone Number:
423-444-3677

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  4902 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 5391 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 103I802362 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".