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NPI Code Detail

MEDICARE: MIND & BODY THERAPEUTIC CONNECTIONS, PLLC

MEDICARE: MIND & BODY THERAPEUTIC CONNECTIONS, 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
11041C0700XClinical Social Worker
2106H00000XMarriage & Family Therapist
3133N00000XNutritionist
4133V00000XRegistered Dietitian
5171100000XAcupuncturist
6363LP0808XPsychiatric/Mental Health Nurse Practitioner
7101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1336767961
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIND & BODY THERAPEUTIC CONNECTIONS, PLLC
Provider Business Mailing Address
First Line : 136 US 70 HWY E
Second Line :
City : GARNER
State : NC
Zip : 27529-3982
Country : US
Telephone Number : 919-791-5611
Fax Number : 919-342-8393
Provider Business Practice Location Address
First Line : 136 US 70 HWY E
Second Line :
City : GARNER
State : NC
Zip : 27529-3982
Country : US
Telephone Number : 919-791-5611
Fax Number :
Authorized Official
Title or Position : OWNER
Name : SUSANN HOPPMANN NAVARRA
Credential :
Telephone Number : 919-791-5611
Provider Enumeration Date : 07/09/2020
Last Update Date : 01/05/2024

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