Provider Demographics
NPI:1003385386
Name:PEACE WITHIN
Entity Type:Organization
Organization Name:PEACE WITHIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:J
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:682-331-2685
Mailing Address - Street 1:5904 S. COOPER STE. 104 - PMB 162
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017
Mailing Address - Country:US
Mailing Address - Phone:682-331-2685
Mailing Address - Fax:682-204-6648
Practice Address - Street 1:5904 S. COOPER STE. 104 - PMB 162
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017
Practice Address - Country:US
Practice Address - Phone:682-331-2685
Practice Address - Fax:682-204-6648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3635153-01Medicaid