Healthcare Provider Details

I. General information

NPI: 1952228447
Provider Name (Legal Business Name): MIND BODY COLLABORATIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2026
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 LAURENCE AVE STE 2
JACKSON MI
49202-2986
US

IV. Provider business mailing address

347 PERSHING AVE
JACKSON MI
49203-1075
US

V. Phone/Fax

Practice location:
  • Phone: 517-930-5479
  • Fax:
Mailing address:
  • Phone: 517-930-5479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: RAELYNN EVERS
Title or Position: OWNER/CLINICAL THERAPIST
Credential: LMSW
Phone: 517-930-5479