Provider Demographics
NPI:1467299453
Name:A PEACEFUL MIND BEHAVIOR SERVICES
Entity type:Organization
Organization Name:A PEACEFUL MIND BEHAVIOR SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER/POINT OF CONTACT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:RENZULLI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:239-533-9604
Mailing Address - Street 1:12381 S CLEVELAND AVE STE 403
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3853
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12381 S CLEVELAND AVE STE 403
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3853
Practice Address - Country:US
Practice Address - Phone:239-266-2620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty