Provider Demographics
NPI:1952963076
Name:PEACEFUL MIND MENTAL HEALTH, LLC
Entity type:Organization
Organization Name:PEACEFUL MIND MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSKINIEMI
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:218-731-8896
Mailing Address - Street 1:PO BOX 341
Mailing Address - Street 2:
Mailing Address - City:NEW YORK MILLS
Mailing Address - State:MN
Mailing Address - Zip Code:56567-0341
Mailing Address - Country:US
Mailing Address - Phone:218-731-8896
Mailing Address - Fax:855-852-5355
Practice Address - Street 1:118 MAIN AVE N STE 203
Practice Address - Street 2:
Practice Address - City:NEW YORK MILLS
Practice Address - State:MN
Practice Address - Zip Code:56567-4405
Practice Address - Country:US
Practice Address - Phone:218-731-8896
Practice Address - Fax:855-852-5355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-29
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health