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General NPI Number Information
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NPI Number | 1467042358
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Entity Type | Organization
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Legal Business Name | INNOVATION MIND & BODY LLC
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Dates
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Enumeration Date | 01/25/2021
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Last Update Date | 01/25/2021
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Provider Practice Location Address
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Address Line | 3303 CYPRESS CREEK PKWY STE 420
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City | HOUSTON
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State | TX
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Zip | 77068-3612
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Country | US
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Telephone | 832-517-9058
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 681583
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City | HOUSTON
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State | TX
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Zip | 77268-1583
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Country | US
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Telephone | 832-517-9058
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | LUCIANA THOMPSON
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Credential | NP
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Telephone | 832-517-9058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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