Provider Demographics
NPI:1053801548
Name:A PEACE OF MIND II, LLC
Entity type:Organization
Organization Name:A PEACE OF MIND II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARASA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-785-4451
Mailing Address - Street 1:12715 HIGHWAY 90 STE 220
Mailing Address - Street 2:
Mailing Address - City:LULING
Mailing Address - State:LA
Mailing Address - Zip Code:70070-2205
Mailing Address - Country:US
Mailing Address - Phone:985-785-4451
Mailing Address - Fax:985-785-4459
Practice Address - Street 1:12715 HIGHWAY 90 STE 220
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-2205
Practice Address - Country:US
Practice Address - Phone:985-785-4451
Practice Address - Fax:985-785-4459
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A PEACE OF MIND II, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2203783821251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health