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General NPI Number Information
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NPI Number | 1366744237
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Entity Type | Organization
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Legal Business Name | MIND BODY HEALTH CONSULTING PLLC
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Dates
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Enumeration Date | 11/29/2010
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Last Update Date | 04/28/2011
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Provider Practice Location Address
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Address Line | 122 S MAIN ST 360-C
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City | ANN ARBOR
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State | MI
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Zip | 48104-1929
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Country | US
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Telephone | 734-645-4262
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Fax |
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Provider Business Mailing Address
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Address Line | 122 S MAIN ST 360-C
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City | ANN ARBOR
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State | MI
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Zip | 48104-1929
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Country | US
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Telephone | 734-645-4262
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER / PRESIDENT
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Name | MS. SARAH FRALEY
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Credential | LMSW, ACSW
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Telephone | 734-645-4262
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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 | 6801068212
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License Number State | MI
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