Provider Demographics
NPI:1265136352
Name:A PEACE OF MINE BY CARLEASE, LLC
Entity type:Organization
Organization Name:A PEACE OF MINE BY CARLEASE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLEASE
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-995-9144
Mailing Address - Street 1:1400 N STATE HIGHWAY 360 APT 1628
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3535
Mailing Address - Country:US
Mailing Address - Phone:918-995-9144
Mailing Address - Fax:
Practice Address - Street 1:1400 N STATE HIGHWAY 360
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3509
Practice Address - Country:US
Practice Address - Phone:918-995-9144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health