Provider Demographics
NPI:1700258514
Name:PEACEFUL MINDS, LLC
Entity Type:Organization
Organization Name:PEACEFUL MINDS, LLC
Other - Org Name:PEACEFUL MINDS WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAUSTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-224-2484
Mailing Address - Street 1:PO BOX 51122
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82605-1122
Mailing Address - Country:US
Mailing Address - Phone:307-224-2484
Mailing Address - Fax:
Practice Address - Street 1:1300 E A ST STE 101
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2211
Practice Address - Country:US
Practice Address - Phone:307-224-2484
Practice Address - Fax:307-222-7784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-20
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY24845.1260261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)