Provider Demographics
NPI:1265922074
Name:PEACEFUL MIND COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:PEACEFUL MIND COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ELYSE
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:DANIELSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:989-370-2511
Mailing Address - Street 1:5274 HAPPY HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48158-9741
Mailing Address - Country:US
Mailing Address - Phone:989-370-2511
Mailing Address - Fax:
Practice Address - Street 1:5274 HAPPY HOLLOW DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48158-9741
Practice Address - Country:US
Practice Address - Phone:989-370-2511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801093070101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty