MEDICARE: THE LOFT MIND BODY SPIRIT COUNSELING PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1063375061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE LOFT MIND BODY SPIRIT COUNSELING PLLC

Provider Business Mailing Address
First Line	:	821 MARIMBA DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-4922
Country	:	US
Telephone Number	:	915-479-2168
Fax Number	:

Provider Business Practice Location Address
First Line	:	821 MARIMBA DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-4922
Country	:	US
Telephone Number	:	915-479-2168
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BETHANY MARIE SHREWSBURY
Credential	:	LPC, S.
Telephone Number	:	915-479-2168

Provider Enumeration Date	:	12/05/2025
Last Update Date	:	12/08/2025

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