Provider Demographics
NPI:1861106403
Name:PEACEFUL PSYCH CONSULTATION SERVICES
Entity type:Organization
Organization Name:PEACEFUL PSYCH CONSULTATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:AMEYIBOR
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:908-590-3544
Mailing Address - Street 1:29A ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:CARTERET
Mailing Address - State:NJ
Mailing Address - Zip Code:07008-2494
Mailing Address - Country:US
Mailing Address - Phone:908-275-7000
Mailing Address - Fax:
Practice Address - Street 1:29A ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:CARTERET
Practice Address - State:NJ
Practice Address - Zip Code:07008-2494
Practice Address - Country:US
Practice Address - Phone:908-275-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty