MEDICARE: MIND BODY SOUL WELLNESS CENTER, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor
3	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1669183927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIND BODY SOUL WELLNESS CENTER, LLC

Provider Business Mailing Address
First Line	:	3070 BRISTOL PIKE STE 2-132
Second Line	:
City	:	BENSALEM
State	:	PA
Zip	:	19020-5363
Country	:	US
Telephone Number	:	267-332-6605
Fax Number	:	267-748-1819

Provider Business Practice Location Address
First Line	:	3070 BRISTOL PIKE STE 2-132
Second Line	:
City	:	BENSALEM
State	:	PA
Zip	:	19020-5363
Country	:	US
Telephone Number	:	267-332-6605
Fax Number	:	267-748-1819

Authorized Official
Title or Position	:	OWNER / PROVIDER
Name	:	BONNIE JEAN KANE
Credential	:	LCPC, LMT
Telephone Number	:	267-332-6605

Provider Enumeration Date	:	12/07/2022
Last Update Date	:	04/17/2026

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