Provider Demographics
NPI:1396438966
Name:MIND AT PEACE PSYCHOTHERAPY
Entity type:Organization
Organization Name:MIND AT PEACE PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:OKUNDAYE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:443-600-5477
Mailing Address - Street 1:1633 RENAISSANCE DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21221-2624
Mailing Address - Country:US
Mailing Address - Phone:443-600-5477
Mailing Address - Fax:443-596-8120
Practice Address - Street 1:511B EASTERN BLVD STE A
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221-6733
Practice Address - Country:US
Practice Address - Phone:443-600-5477
Practice Address - Fax:443-596-8120
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIND AT PEACE PSYCHOTHERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-31
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty