Provider Demographics
NPI:1881197168
Name:PEACE OF MIND COUNSELING, CONSULTING, AND SUPERVISION LLC
Entity Type:Organization
Organization Name:PEACE OF MIND COUNSELING, CONSULTING, AND SUPERVISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:517-316-6600
Mailing Address - Street 1:4025 HOLT RD STE 205
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-6019
Mailing Address - Country:US
Mailing Address - Phone:517-881-7231
Mailing Address - Fax:
Practice Address - Street 1:4025 HOLT RD STE 205
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-6019
Practice Address - Country:US
Practice Address - Phone:517-881-7231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012915101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty