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General NPI Number Information
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NPI Number | 1093472581
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Entity Type | Organization
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Legal Business Name | MIND BODY & HEALTH, LLC
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Dates
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Enumeration Date | 11/19/2021
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Last Update Date | 01/30/2024
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Provider Practice Location Address
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Address Line | 349 CENTER ST
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City | ASHTABULA
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State | OH
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Zip | 44004-6901
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Country | US
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Telephone | 440-812-7108
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Fax |
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Provider Business Mailing Address
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Address Line | 349 CENTER ST
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City | ASHTABULA
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State | OH
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Zip | 44004-6901
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | VANESSA REYES
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Credential | CMA
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Telephone | 440-364-4741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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