Provider Demographics
NPI:1831784453
Name:PEACEFUL SOLUTIONS THERAPY, LLC
Entity type:Organization
Organization Name:PEACEFUL SOLUTIONS THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYNDEL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LINDSEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:601-596-2625
Mailing Address - Street 1:1700 W GOVERNMENT ST STE E
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-2420
Mailing Address - Country:US
Mailing Address - Phone:769-234-5409
Mailing Address - Fax:
Practice Address - Street 1:460 BRIARWOOD DR # 400-52
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-3051
Practice Address - Country:US
Practice Address - Phone:601-596-2625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-05
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09283279Medicaid