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General NPI Number Information
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NPI Number | 1871302836
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Entity Type | Organization
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Legal Business Name | MIND BODY SOUL ALIGNED LLC
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Dates
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Enumeration Date | 01/04/2025
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Last Update Date | 01/04/2025
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Provider Practice Location Address
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Address Line | 127 EASTGATE DR STE B201
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City | LOS ALAMOS
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State | NM
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Zip | 87544-3300
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Country | US
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Telephone | 505-381-5301
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Fax |
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Provider Business Mailing Address
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Address Line | 300 JOYA LOOP
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City | WHITE ROCK
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State | NM
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Zip | 87547-3707
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Country | US
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Telephone | 605-360-8918
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHELSIE MARIE MILLER
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Credential | MA, LPCC
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Telephone | 505-381-5301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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