Provider Demographics
NPI:1083074025
Name:PEACE OF MIND THERAPEUTIC SOLUTIONS
Entity Type:Organization
Organization Name:PEACE OF MIND THERAPEUTIC SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAFAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSTYSTALLWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:916-596-5613
Mailing Address - Street 1:1002 RIVER ROCK DR STE 221
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-2094
Mailing Address - Country:US
Mailing Address - Phone:916-889-5101
Mailing Address - Fax:
Practice Address - Street 1:1002 RIVER ROCK DR STE 221
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-2094
Practice Address - Country:US
Practice Address - Phone:916-889-5101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health