Provider Demographics
NPI:1538979067
Name:PEACEFULMIND BEHAVIORAL LLC
Entity type:Organization
Organization Name:PEACEFULMIND BEHAVIORAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SMINK
Authorized Official - Middle Name:
Authorized Official - Last Name:ACHILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-382-4062
Mailing Address - Street 1:7312 DARSENA GRAND
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054
Mailing Address - Country:US
Mailing Address - Phone:682-382-4062
Mailing Address - Fax:
Practice Address - Street 1:17470 N PACESETTER WAY
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-5445
Practice Address - Country:US
Practice Address - Phone:682-382-4062
Practice Address - Fax:602-922-0028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty