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General NPI Number Information
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NPI Number | 1992516686
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Entity Type | Organization
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Legal Business Name | BODY AND MIND HEALTH CARE, LLC
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Dates
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Enumeration Date | 01/14/2025
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 1521 JOE BATTLE BLVD
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City | EL PASO
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State | TX
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Zip | 79936-0922
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Country | US
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Telephone | 808-216-5179
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Fax |
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Provider Business Mailing Address
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Address Line | 12193 DOS RIOS DR
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City | EL PASO
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State | TX
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Zip | 79936-0260
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Country | US
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Telephone | 808-216-5179
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIC AND FAMILY NP
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Name | DR. KENYUA NIKIA JOHNSON
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Credential | DNP
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Telephone | 808-216-5179
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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