Provider Demographics
NPI:1467289983
Name:WALKING PEACE
Entity type:Organization
Organization Name:WALKING PEACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAINES
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:573-289-8495
Mailing Address - Street 1:413 E SPRING ST
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65233-1573
Mailing Address - Country:US
Mailing Address - Phone:573-289-8495
Mailing Address - Fax:660-882-7137
Practice Address - Street 1:413 E SPRING ST
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:MO
Practice Address - Zip Code:65233-1573
Practice Address - Country:US
Practice Address - Phone:573-289-8495
Practice Address - Fax:660-882-7137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)