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General NPI Number Information
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NPI Number | 1285457135
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Entity Type | Organization
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Legal Business Name | MIND-BODY TRAUMA THERAPY LLC
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Dates
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Enumeration Date | 11/07/2024
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 793 E 1055TH RD
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City | BALDWIN CITY
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State | KS
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Zip | 66006-7287
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Country | US
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Telephone | 913-424-6230
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Fax |
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Provider Business Mailing Address
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Address Line | 793 E 1055TH RD
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City | BALDWIN CITY
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State | KS
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Zip | 66006-7287
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Country | US
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Telephone | 913-424-6230
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Fax |
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Authorized Official
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Title or Position | THERAPIST/OWNER
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Name | ELIZABETH MOFFITT
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Credential |
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Telephone | 913-424-6239
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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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Taxonomy #2
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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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Taxonomy #3
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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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