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General NPI Number Information
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NPI Number | 1629934823
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Entity Type | Organization
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Legal Business Name | MIND-BODY THERAPEUTICS
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Dates
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Enumeration Date | 12/31/2025
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Last Update Date | 12/31/2025
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Provider Practice Location Address
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Address Line | 86B MARTIN LN
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City | MORIARTY
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State | NM
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Zip | 87035-5605
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Country | US
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Telephone | 505-895-3483
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Fax | 715-504-8663
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Provider Business Mailing Address
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Address Line | 86B MARTIN LN
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City | MORIARTY
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State | NM
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Zip | 87035-5605
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Country | US
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Telephone | 505-895-3483
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Fax | 715-504-8663
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Authorized Official
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Title or Position | OWNER
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Name | JULIE ANN WILSON
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Credential | LPCC
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Telephone | 505-895-3484
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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 |
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License Number State |
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