Provider Demographics
NPI:1942507991
Name:PEACEFUL HEALING FOR KIDS INC
Entity Type:Organization
Organization Name:PEACEFUL HEALING FOR KIDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC CSW MA NBCC ACS
Authorized Official - Phone:908-455-1058
Mailing Address - Street 1:140 LITTLETON RD STE 305
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-1867
Mailing Address - Country:US
Mailing Address - Phone:908-455-1058
Mailing Address - Fax:888-834-0604
Practice Address - Street 1:140 LITTLETON RD STE 305
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-1867
Practice Address - Country:US
Practice Address - Phone:908-455-1058
Practice Address - Fax:888-834-0604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00330000251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0162086Medicaid
NJ27461807Medicaid