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General NPI Number Information
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NPI Number | 1942682737
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Entity Type | Organization
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Legal Business Name | MIND, BODY & SOUL, INC.
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Dates
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Enumeration Date | 06/29/2015
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Last Update Date | 06/29/2015
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Provider Practice Location Address
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Address Line | 1139 GEMBLER RD
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City | SAN ANTONIO
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State | TX
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Zip | 78219-3224
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Country | US
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Telephone | 210-551-8244
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Fax | 210-263-9765
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Provider Business Mailing Address
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Address Line | 6039 LAKEVIEW DR
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City | SAN ANTONIO
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State | TX
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Zip | 78244-1689
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Country | US
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Telephone | 210-551-8244
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Fax | 210-263-9765
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MR. ALBERT BRYAN
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Credential | LCDC/MSW
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Telephone | 210-551-8244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 10715
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License Number State | TX
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