Healthcare Provider Details

I. General information

NPI: 1245958123
Provider Name (Legal Business Name): MIND BODY WELLNESS CLINICAL TENNESSEE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2022
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 COOL SPRINGS BLVD STE 140
FRANKLIN TN
37067-6449
US

IV. Provider business mailing address

16 VILLAGE LN STE 200
COLLEYVILLE TX
76034-2948
US

V. Phone/Fax

Practice location:
  • Phone: 469-991-7647
  • Fax: 682-477-3694
Mailing address:
  • Phone: 469-991-7647
  • Fax: 682-477-3694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE LEE RINEHART
Title or Position: CREDENTIALING & CONTRACTS SPECIALIS
Credential:
Phone: 682-316-1856