Provider Demographics
NPI:1255720389
Name:PEACEFUL MIND THERAPY, P.A.
Entity type:Organization
Organization Name:PEACEFUL MIND THERAPY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:239-272-6214
Mailing Address - Street 1:2180 IMMOKALEE RD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1421
Mailing Address - Country:US
Mailing Address - Phone:239-272-6214
Mailing Address - Fax:239-596-8901
Practice Address - Street 1:2180 IMMOKALEE RD
Practice Address - Street 2:SUITE 216
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1421
Practice Address - Country:US
Practice Address - Phone:239-272-6214
Practice Address - Fax:239-596-8901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12440101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty