MEDICARE: MIND BODY WELLNESS SOLUTIONS

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	261QP2300X	Primary Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1003044330	OTHER	TX	NPI NUMBER

General Provider Information

NPI Number	:	1891333753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIND BODY WELLNESS SOLUTIONS

Provider Business Mailing Address
First Line	:	3408 SAM HOUSTON DR
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77904-2238
Country	:	US
Telephone Number	:	361-844-8866
Fax Number	:	361-894-6064

Provider Business Practice Location Address
First Line	:	3408 SAM HOUSTON DR
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77904-2238
Country	:	US
Telephone Number	:	361-844-8866
Fax Number	:	361-894-6064

Authorized Official
Title or Position	:	RN, FNP
Name	:	GINGER CARVER
Credential	:
Telephone Number	:	361-844-8866

Provider Enumeration Date	:	12/11/2019
Last Update Date	:	12/11/2019

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Directions to “MIND BODY WELLNESS SOLUTIONS ” Practice Location

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