Healthcare Provider Details

I. General information

NPI: 1598037400
Provider Name (Legal Business Name): MIND/BODY HEALTH & PSYCHOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6115 ESTATE SMITH BAY SUITE 334 & 335
ST THOMAS VI
00802-1324
US

IV. Provider business mailing address

PO BOX 12137
ST THOMAS VI
00801-5137
US

V. Phone/Fax

Practice location:
  • Phone: 340-626-8106
  • Fax:
Mailing address:
  • Phone: 340-626-8106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number10-029 PSY
License Number StateVI

VIII. Authorized Official

Name: DR. SHEENA MYONG WALKER
Title or Position: OWNER
Credential: PH.D.
Phone: 340-626-8106