=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093115347
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIND-BODY CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2014
-----------------------------------------------------
Last Update Date | 08/11/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2672 BAYSHORE PKWY STE 1045
-----------------------------------------------------
City | MOUNTAIN VIEW
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94043-1015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-862-7320
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6754 BERNAL AVE # 740-285
-----------------------------------------------------
City | PLEASANTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94566-1232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-862-7320
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | DR. SHILPA KAPOOR
-----------------------------------------------------
Credential | PSY.D
-----------------------------------------------------
Telephone | 508-627-3206
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY26333
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------