NPIMap

Organization Active NPI

Peaceful Mind Behavioral Health & Wellness, LLC

  • Mental Health Counselor
  • Bristol, CT
National Provider Identifier
1255926358
Registry record updated Oct 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
PEACEFUL MIND BEHAVIORAL HEALTH & WELLNESS, LLC
Practice address
123 Middle Street
Bristol, CT 06010-7404
Phone
(860) 281-2280
Fax
(860) 499-3514
NPI assigned
Mar 2, 2021
Last updated
Oct 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Miss Morgan Poeta, LPCNPI 1114593993
Title
Owner/LPC
Phone
(860) 281-2280

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 13

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X NU
Addiction (Substance Use Disorder) Counselor 101YA0400X NU
Mental Health Counselor 101YM0800X NU Primary
Professional Counselor 101YP2500X NU
Psychologist 103T00000X NU
Adult Development & Aging Psychologist 103TA0700X NU
Counseling Psychologist 103TC1900X NU
Group Psychotherapy Psychologist 103TP2701X NU
Clinical Social Worker 1041C0700X NU
Marriage & Family Therapist 106H00000X NU
Public Health & General Preventive Medicine Physician 2083P0901X NU
Nurse Practitioner 363L00000X NU
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU

Addresses

Primary practice location

123 Middle Street
Bristol, CT 06010-7404

Mailing address

123 Middle Street
Bristol, CT 06010-7404
Phone (860) 281-2280

Other practice location 1

135 Middle Street
Building D Unit 2
Bristol, CT 06010
Phone (608) 281-2280

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220822002310 CT Part B Supplier - Clinic/Group Practice 0941683056 Receives reassigned benefits from 18 practitioners
Practice locations: Bristol, CT

National Provider Directory

National Provider Directory
Tax ID family
Peaceful Mind Behavioral Health Wellness LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

123 Middle St
Bristol, CT 06010
Phone (860) 281-2280

115 N Main St
Southington, CT 06489
Phone (860) 281-2280

Practitioners & affiliated clinicians

Practitioners 37

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 37

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728604800000",
    "number": "1255926358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 MIDDLE STREET",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "060107404",
            "telephone_number": "860-281-2280",
            "fax_number": "860-499-3514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 MIDDLE STREET",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "060107404",
            "telephone_number": "860-281-2280",
            "fax_number": "860-499-3514"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "135 Middle Street",
            "address_2": "Building D Unit 2",
            "address_purpose": "LOCATION",
            "city": "Bristol",
            "state": "CT",
            "postal_code": "06010",
            "country_code": "US",
            "telephone_number": "608-281-2280",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PEACEFUL MIND BEHAVIORAL HEALTH & WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-02",
        "last_updated": "2024-10-11",
        "certification_date": "2024-10-11",
        "status": "A",
        "authorized_official_last_name": "POETA",
        "authorized_official_first_name": "MORGAN",
        "authorized_official_title_or_position": "OWNER/LPC",
        "authorized_official_telephone_number": "860-281-2280",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TA0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bristol, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.