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General NPI Number Information
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NPI Number | 1124685037
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Entity Type | Organization
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Legal Business Name | MIND BODY CONNECTIONS LLC
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Dates
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Enumeration Date | 05/26/2019
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Last Update Date | 05/26/2019
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Provider Practice Location Address
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Address Line | 5415 N MCCOLL RD STE 103
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City | MCALLEN
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State | TX
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Zip | 78504-4664
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Country | US
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Telephone | 956-250-2373
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Fax | 956-524-5642
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Provider Business Mailing Address
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Address Line | PO BOX 4125
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City | EDINBURG
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State | TX
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Zip | 78540-4125
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Country | US
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Telephone | 956-250-2373
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Fax | 956-524-5642
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Authorized Official
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Title or Position | LPC-S/ OWNER
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Name | MS. ROXANNE A. TREVINO
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Credential | LPC-S
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Telephone | 956-250-2373
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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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