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General NPI Number Information
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NPI Number | 1720238439
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Entity Type | Organization
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Legal Business Name | BODYMIND CONNECTIONS LLC
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Dates
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Enumeration Date | 09/30/2008
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Last Update Date | 11/06/2008
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Provider Practice Location Address
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Address Line | 409 VANDIVER DR BLDG 6 SUITE 104
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City | COLUMBIA
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State | MO
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Zip | 65202-3754
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Country | US
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Telephone | 573-442-5475
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Fax | 573-442-5145
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Provider Business Mailing Address
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Address Line | 409 VANDIVER DR BLDG 6 SUITE 104
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City | COLUMBIA
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State | MO
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Zip | 65202-3754
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Country | US
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Telephone | 573-442-5475
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Fax | 573-442-5145
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Authorized Official
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Title or Position | PROVIDER
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Name | MRS. BETH RACHAEL PARKER
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Credential | LCSW
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Telephone | 573-442-5475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 002930
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License Number State | MO
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