Provider Demographics
NPI:1295206118
Name:PEACE OF MIND COUNSELING AND EDUCATIONAL SERVICES
Entity Type:Organization
Organization Name:PEACE OF MIND COUNSELING AND EDUCATIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:512-318-2503
Mailing Address - Street 1:PO BOX 80233
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78708-0233
Mailing Address - Country:US
Mailing Address - Phone:512-318-2503
Mailing Address - Fax:
Practice Address - Street 1:7901 CAMERON RD STE 2-239
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-3814
Practice Address - Country:US
Practice Address - Phone:512-318-2503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX328849001Medicaid