Provider Demographics
NPI:1760115695
Name:PEACE OF MIND THERAPY, LLC
Entity Type:Organization
Organization Name:PEACE OF MIND THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SYREETA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:442-327-9135
Mailing Address - Street 1:14393 PARK AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-3302
Mailing Address - Country:US
Mailing Address - Phone:442-327-9135
Mailing Address - Fax:
Practice Address - Street 1:14393 PARK AVE STE 200
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-3302
Practice Address - Country:US
Practice Address - Phone:442-327-9135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty