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General NPI Number Information
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NPI Number | 1689864571
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Entity Type | Organization
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Legal Business Name | MIND BODY ASSOCIATES, INC.
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Dates
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Enumeration Date | 07/27/2007
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Last Update Date | 07/27/2007
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Provider Practice Location Address
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Address Line | 1869 PORTER LAKE DR
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City | SARASOTA
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State | FL
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Zip | 34240-7893
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Country | US
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Telephone | 941-377-8111
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Fax | 941-377-8778
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Provider Business Mailing Address
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Address Line | 5436 FRUITVILLE RD # 150
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City | SARASOTA
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State | FL
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Zip | 34232-6403
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Country | US
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Telephone | 941-377-8111
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Fax | 941-377-8778
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Authorized Official
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Title or Position | PRESIDENT
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Name | JULIE M SIMONS
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Credential | LCSW
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Telephone | 941-377-8111
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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 | 4716
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License Number State | FL
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