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General NPI Number Information
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NPI Number | 1073077111
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Entity Type | Organization
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Legal Business Name | MINDBODYOLOGY FAMILY THERAPY INC
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Dates
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Enumeration Date | 01/23/2019
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Last Update Date | 03/24/2022
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Provider Practice Location Address
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Address Line | 440 S MELROSE DR STE 200
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City | VISTA
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State | CA
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Zip | 92081-6666
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Country | US
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Telephone | 833-444-6463
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Fax |
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Provider Business Mailing Address
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Address Line | 440 S MELROSE DR STE 202
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City | VISTA
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State | CA
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Zip | 92081-6666
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Country | US
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Telephone | 833-444-6463
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHALISS PADILLA
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Credential | LMFT
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Telephone | 833-444-6463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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