Healthcare Provider Details

I. General information

NPI: 1770390528
Provider Name (Legal Business Name): MIND BODY THERAPY STUDIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 S UNIVERSITY DR STE 254
DAVIE FL
33328-3836
US

IV. Provider business mailing address

4801 S UNIVERSITY DR STE 254
DAVIE FL
33328-3836
US

V. Phone/Fax

Practice location:
  • Phone: 786-408-5052
  • Fax:
Mailing address:
  • Phone: 786-408-5052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TATIANA SCHARR
Title or Position: THERAPIST
Credential: LCSW
Phone: 786-408-5052