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General NPI Number Information
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NPI Number | 1508540956
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Entity Type | Organization
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Legal Business Name | MIND AND BODY WELLNESS, LLC.
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Dates
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Enumeration Date | 06/14/2023
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Last Update Date | 08/06/2024
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Provider Practice Location Address
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Address Line | 720 LEXINGTON AVE
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City | FORT SMITH
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State | AR
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Zip | 72901-4738
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Country | US
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Telephone | 479-910-3169
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Fax | 479-600-5051
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Provider Business Mailing Address
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Address Line | PO BOX 6632
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City | SPRINGDALE
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State | AR
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Zip | 72766-6632
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Country | US
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Telephone | 479-409-6049
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Fax | 479-600-5051
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Authorized Official
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Title or Position | OWNER
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Name | LUCINDA J SHEPHERD
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Credential |
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Telephone | 479-409-6049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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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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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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