MEDICARE: MIND AND BODY WELLNESS CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	44725	OTHER	TN	LICENSE

General Provider Information

NPI Number	:	1063048668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIND AND BODY WELLNESS CLINIC

Provider Business Mailing Address
First Line	:	1176 VICKERY LN STE 100
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38016-0631
Country	:	US
Telephone Number	:	901-737-1992
Fax Number	:	901-309-8784

Provider Business Practice Location Address
First Line	:	1176 VICKERY LN STE 100
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38016-0631
Country	:	US
Telephone Number	:	901-737-1992
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	TONYA M MALADY
Credential	:
Telephone Number	:	901-737-1992

Provider Enumeration Date	:	03/16/2020
Last Update Date	:	03/16/2020

Similar Medicare Providers

1134075948 — ZACHARY JONES
Practice Location Address:

1176 VICKERY LN STE 100
CORDOVA, TN
38016-0631

Practice Phone: 901-341-3521
Practice Fax: 901-341-5993

1992043749 — PRECISION MENTAL HEALTH LLP
Practice Location Address:

1176 VICKERY LN STE 100
CORDOVA, TN
38016-0631

Practice Phone: 901-737-1992
Practice Fax: 901-309-8784

1215569207 — INTERNAL HEALTH AND MEDICAL SERVICES LLC
Practice Location Address:

1176 VICKERY LN STE 220
CORDOVA, TN
38016-0631

Practice Phone: 901-421-5174
Practice Fax: 901-249-6179

1215543251 — KENYATTA PUGH
Practice Location Address:

1176 VICKERY LN STE 200
CORDOVA, TN
38016-0631

Practice Phone: 901-255-4490
Practice Fax: 901-416-4490

1841877198 — HARMONY HAVEN BEHAVIORAL HEALTH
Practice Location Address:

1176 VICKERY LN STE 100
CORDOVA, TN
38016-0631

Practice Phone: 901-519-2890
Practice Fax:

1033978291 — IHMS HEALTHCARE INCORPORATED
Practice Location Address:

1176 VICKERY LN STE 220
CORDOVA, TN
38016-0631

Practice Phone: 901-421-5174
Practice Fax: 901-421-5967

Directions to “MIND AND BODY WELLNESS CLINIC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.