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General NPI Number Information
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NPI Number | 1285102939
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Entity Type | Organization
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Legal Business Name | BODY AND SPIRIT WELLNESS
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Dates
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Enumeration Date | 11/09/2018
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Last Update Date | 08/16/2019
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Provider Practice Location Address
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Address Line | 980 W 17TH ST STE C
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City | SANTA ANA
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State | CA
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Zip | 92706-3554
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Country | US
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Telephone | 714-606-8185
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Fax | 949-932-0901
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Provider Business Mailing Address
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Address Line | PO BOX 6464
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City | SANTA ANA
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State | CA
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Zip | 92706-0464
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Country | US
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Telephone | 714-606-8185
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Fax | 949-932-0901
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CARMEN R THOMAS
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Credential | LMFT
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Telephone | 714-606-8185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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