Provider Demographics
NPI:1023513371
Name:PEACEFUL MIND PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:PEACEFUL MIND PSYCHOTHERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHOUH-RONG
Authorized Official - Middle Name:VIVIAN
Authorized Official - Last Name:TSAI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:240-651-3890
Mailing Address - Street 1:5301 BUCKEYSTOWN PIKE STE 440
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-8370
Mailing Address - Country:US
Mailing Address - Phone:240-651-3890
Mailing Address - Fax:240-815-6015
Practice Address - Street 1:5301 BUCKEYSTOWN PIKE STE 440
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-8370
Practice Address - Country:US
Practice Address - Phone:240-651-3890
Practice Address - Fax:240-815-6015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-28
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05117103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty