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General NPI Number Information
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NPI Number | 1598391229
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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 | 03/13/2020
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 6825 WHITE EGRET CT
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City | TINLEY PARK
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State | IL
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Zip | 60477-3973
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Country | US
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Telephone | 630-546-2465
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Fax |
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Provider Business Mailing Address
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Address Line | 6825 WHITE EGRET CT
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City | TINLEY PARK
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State | IL
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Zip | 60477-3973
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Country | US
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Telephone | 630-546-2465
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TALIA NELSON
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Credential |
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Telephone | 708-260-2030
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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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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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