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General NPI Number Information
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NPI Number | 1134789563
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Entity Type | Organization
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Legal Business Name | MIND, BODY & SPIRIT MARRIAGE AND FAMILY THERAPY
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Dates
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Enumeration Date | 06/18/2019
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Last Update Date | 06/01/2021
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Provider Practice Location Address
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Address Line | 159 FOREST HILL DR
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City | SYRACUSE
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State | NY
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Zip | 13206-2807
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Country | US
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Telephone | 315-243-1083
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 186
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City | SYRACUSE
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State | NY
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Zip | 13201-0186
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Country | US
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Telephone | 315-243-1083
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RHEA PARKS
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Credential | LMFT
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Telephone | 315-243-1083
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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