NPIMap

Organization Active NPI

Peaceful Mind Mental Health, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • New York Mills, MN
National Provider Identifier
1952963076
Registry record updated Apr 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
PEACEFUL MIND MENTAL HEALTH, LLC
Practice address
118 Main Ave N Ste 203
New York Mills, MN 56567-4405
Phone
(218) 731-8896
Fax
(855) 852-5355
NPI assigned
Jun 29, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2022

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

Authorized official

Name
Rebecca Koskiniemi, LICSWNPI 1861956948
Title
Therapist
Phone
(218) 731-8896

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary
Adult Mental Health Clinic/Center 261QM0850X
Adolescent and Children Mental Health Clinic/Center 261QM0855X

Addresses

Primary practice location

118 Main Ave N Ste 203
New York Mills, MN 56567-4405

Mailing address

PO Box 341
New York Mills, MN 56567-0341
Phone (218) 731-8896

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200819001389 MN Part B Supplier - Clinic/Group Practice 3173949393 Receives reassigned benefits from 1 practitioner
Practice locations: New York Mills, MN

National Provider Directory

National Provider Directory

Locations

125 W Lincoln Ave
Ste 10
Fergus Falls, MN 56537
Phone (218) 205-1079

Practitioners & affiliated clinicians

Practitioners 4

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": "1561766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649635200000",
    "number": "1952963076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 341",
            "city": "NEW YORK MILLS",
            "state": "MN",
            "postal_code": "565670341",
            "telephone_number": "218-731-8896",
            "fax_number": "855-852-5355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 MAIN AVE N STE 203",
            "city": "NEW YORK MILLS",
            "state": "MN",
            "postal_code": "565674405",
            "telephone_number": "218-731-8896",
            "fax_number": "855-852-5355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACEFUL MIND MENTAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-29",
        "last_updated": "2022-04-11",
        "certification_date": "2022-04-11",
        "status": "A",
        "authorized_official_last_name": "KOSKINIEMI",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "218-731-8896",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York Mills, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2022; 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.