Provider Demographics
NPI:1841792751
Name:PEACEFUL MIND THERAPY, LLC
Entity Type:Organization
Organization Name:PEACEFUL MIND THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ODELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUHEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-325-4670
Mailing Address - Street 1:4169 CRAIGEND LOOP
Mailing Address - Street 2:
Mailing Address - City:GULF SHORES
Mailing Address - State:AL
Mailing Address - Zip Code:36542-5822
Mailing Address - Country:US
Mailing Address - Phone:702-325-4670
Mailing Address - Fax:
Practice Address - Street 1:2509 TANBARK CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-3876
Practice Address - Country:US
Practice Address - Phone:702-254-6703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-06
Last Update Date:2023-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)