Provider Demographics
NPI:1619552726
Name:PEACE OF MIND, NEPA, LLC
Entity Type:Organization
Organization Name:PEACE OF MIND, NEPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSSUTH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:570-457-4747
Mailing Address - Street 1:1201 S MAIN ST REAR
Mailing Address - Street 2:
Mailing Address - City:OLD FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:18518-2365
Mailing Address - Country:US
Mailing Address - Phone:570-457-4747
Mailing Address - Fax:570-457-4747
Practice Address - Street 1:1201 S MAIN ST REAR
Practice Address - Street 2:
Practice Address - City:OLD FORGE
Practice Address - State:PA
Practice Address - Zip Code:18518-2365
Practice Address - Country:US
Practice Address - Phone:570-499-4290
Practice Address - Fax:570-457-4747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-10
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty