MEDICARE: ELEMENTAL BODY & MIND

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518782663
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEMENTAL BODY & MIND

Provider Business Mailing Address
First Line	:	201 E MARKET ST STE 3
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-3362
Country	:	US
Telephone Number	:	812-408-3674
Fax Number	:	812-407-8126

Provider Business Practice Location Address
First Line	:	201 E MARKET ST STE 3
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-3362
Country	:	US
Telephone Number	:	812-408-3674
Fax Number	:	812-407-8126

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES HAVEN RN APRN HAVEN
Credential	:	APRN
Telephone Number	:	812-408-3674

Provider Enumeration Date	:	11/22/2024
Last Update Date	:	04/10/2026

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Directions to “ELEMENTAL BODY & MIND ” Practice Location

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