Organization
PEACE OF MIND FUNCTIONAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY KATE COPPEDGE PMHNP (OWNER)
(541) 222-9231
Entity
Organization
Contact information
Practice address
151 SW SHEVLIN HIXON DR STE 201, BEND, OR 97702-3233
(458) 202-9231
(541) 797-6113
Mailing address
151 SW SHEVLIN HIXON DR STE 201, BEND, OR 97702-3233
(458) 202-9231
(541) 797-6113
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1194057661
—
OR
Enumeration date
03/18/2020
Last updated
03/18/2020
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