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General NPI Number Information
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NPI Number | 1205084118
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Entity Type | Organization
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Legal Business Name | MIND BODY PROGRAM LLC
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Dates
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Enumeration Date | 09/04/2008
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 199 COUNTY ROAD DF FL 3
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City | JUNEAU
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State | WI
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Zip | 53039-9512
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Country | US
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Telephone | 920-386-4094
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Fax | 920-386-4564
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Provider Business Mailing Address
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Address Line | 15300 WATERTOWN PLANK RD STE 106
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City | ELM GROVE
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State | WI
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Zip | 53122-2348
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Country | US
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Telephone | 414-807-8934
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. LAURI CHRISTINE GEBHARD
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Credential | PHD
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Telephone | 414-807-8934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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