Provider Demographics
NPI:1558019315
Name:PEACE AND MIND THERAPY CENTER
Entity Type:Organization
Organization Name:PEACE AND MIND THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JADE
Authorized Official - Middle Name:E
Authorized Official - Last Name:FREDERICK
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-266-0475
Mailing Address - Street 1:1269 WOODFIELD ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-1766
Mailing Address - Country:US
Mailing Address - Phone:248-506-6936
Mailing Address - Fax:
Practice Address - Street 1:1269 WOODFIELD ST
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48362-1766
Practice Address - Country:US
Practice Address - Phone:248-506-6936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty