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General NPI Number Information
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NPI Number | 1750140786
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Entity Type | Organization
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Legal Business Name | MINDBODY HEALTH & WELLNESS CLINIC LLC
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Dates
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Enumeration Date | 03/13/2024
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Last Update Date | 03/13/2024
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Provider Practice Location Address
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Address Line | 415 STATE ST.
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City | NATCHEZ
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State | MS
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Zip | 39120
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Country | US
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Telephone | 769-355-2138
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Fax |
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Provider Business Mailing Address
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Address Line | 105 NORTHAMPTON RD
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City | NATCHEZ
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State | MS
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Zip | 39120-5274
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | URSULA BROOKS-CLEMONS
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Credential |
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Telephone | 769-355-2138
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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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