NPIMap

Organization Active NPI

Peace of Mind Therapy Services

  • Clinical Social Worker
  • Johnson City, TN
National Provider Identifier
1265796072
Registry record updated Jun 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
5391 Issued in TN
Legal business name
PEACE OF MIND THERAPY SERVICES
Practice address
207 Boone St
Suite 27
Johnson City, TN 37604-5603
Phone
(423) 444-3677
Fax
(423) 244-0602
NPI assigned
Jun 26, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2012

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

Authorized official

Name
Mr. Jonathan L Hartsell, LCSWNPI 1326347311
Title
Therapist
Phone
(423) 444-3677

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X 5391 TN Primary
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X 4902 TN

Addresses

Primary practice location

207 Boone St
Suite 27
Johnson City, TN 37604-5603

Mailing address

207 Boone St
Suite 27
Johnson City, TN 37604-5603
Phone (423) 444-3677

Other identifiers 1

IdentifierTypeStateIssuer
103I802362OtherMEDICARE PTAN

National Provider Directory

National Provider Directory

Locations

207 N Boone St
Ste 27
Johnson City, TN 37604
Phone (423) 444-3677

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1340668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340668800000",
    "number": "1265796072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 BOONE ST",
            "address_2": "SUITE 27",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376045603",
            "telephone_number": "423-444-3677",
            "fax_number": "423-244-0602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 BOONE ST",
            "address_2": "SUITE 27",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376045603",
            "telephone_number": "423-444-3677",
            "fax_number": "423-244-0602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACE OF MIND THERAPY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-26",
        "last_updated": "2012-06-26",
        "status": "A",
        "authorized_official_last_name": "HARTSELL",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "423-444-3677",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "TN",
            "license": "5391",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "TN",
            "license": "4902",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "103I802362",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.