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General NPI Number Information
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NPI Number | 1215632476
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Entity Type | Organization
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Legal Business Name | MIND & BODY PSYCHOTHERAPY INC
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Dates
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Enumeration Date | 04/04/2023
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Last Update Date | 04/04/2023
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Provider Practice Location Address
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Address Line | 201 E GRAND AVE STE 2A
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City | ESCONDIDO
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State | CA
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Zip | 92025-2818
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Country | US
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Telephone | 619-395-2885
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Fax |
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Provider Business Mailing Address
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Address Line | 1026 W EL NORTE PKWY # 48
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City | ESCONDIDO
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State | CA
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Zip | 92026-3341
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Country | US
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Telephone | 619-395-2885
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOLOGIST
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Name | DR. LEANNE SELF
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Credential | PSY.D.
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Telephone | 619-395-2885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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