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General NPI Number Information
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NPI Number | 1083471601
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Entity Type | Organization
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Legal Business Name | MIND BODY MEDICAL SERVICES, P.C. OF CO
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Dates
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Enumeration Date | 02/29/2024
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Last Update Date | 02/29/2024
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Provider Practice Location Address
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Address Line | 1136 5TH AVE APT 7B
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City | NEW YORK
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State | NY
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Zip | 10128-0122
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Country | US
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Telephone | 888-729-1971
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Fax |
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Provider Business Mailing Address
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Address Line | 1136 5TH AVE APT 7B
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City | NEW YORK
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State | NY
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Zip | 10128-0122
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Country | US
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Telephone | 888-729-1971
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Fax |
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Authorized Official
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Title or Position | CARE OPERATIONS MANAGER
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Name | LAURA HOLLANDER
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Credential | MPH
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Telephone | 888-729-1971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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