Provider Demographics
NPI:1932614799
Name:PEACE OF MIND MENTAL HEALTH, INC.
Entity Type:Organization
Organization Name:PEACE OF MIND MENTAL HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:786-732-0071
Mailing Address - Street 1:18901 SW 106TH AVE STE 224
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-7665
Mailing Address - Country:US
Mailing Address - Phone:786-732-0071
Mailing Address - Fax:305-964-5435
Practice Address - Street 1:18901 SW 106TH AVE STE 224
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-7665
Practice Address - Country:US
Practice Address - Phone:786-732-0071
Practice Address - Fax:305-964-5435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-02
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13706261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111593000Medicaid
FL011938200Medicaid