Healthcare Provider Details

I. General information

NPI: 1386959922
Provider Name (Legal Business Name): MIND & BODY THERAPIES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2010
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E 22ND ST STE E
VANCOUVER WA
98663-3266
US

IV. Provider business mailing address

200 E 22ND ST STE E
VANCOUVER WA
98663-3266
US

V. Phone/Fax

Practice location:
  • Phone: 360-696-2744
  • Fax: 360-696-4811
Mailing address:
  • Phone: 360-696-2744
  • Fax: 360-696-4811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberPY 2523
License Number StateWA

VIII. Authorized Official

Name: DR. CHERYL M LOWE
Title or Position: PSYCHOLOGIST/OWNER
Credential: PSYD
Phone: 360-696-2744