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Organization
PEACE OF MIND THERAPY, PLLC
Active
Organization
PEACE OF MIND THERAPY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAUREN LUCIELLE PROVENCHER LMSW (OWNER/CLINICAL THERAPIST)
(248) 397-4705
Entity
Organization
Contact information
Practice address
2615 W 12 MILE RD STE 119, BERKLEY, MI 48072-1627
(248) 397-4705
Mailing address
2615 W 12 MILE RD STE 119, BERKLEY, MI 48072-1627
(248) 397-4705
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6801093391
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1285918631
BCBS/BCN
MI
Enumeration date
03/20/2018
Last updated
05/05/2018
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