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NPI Code Detail

MEDICARE: MIND BODY WELLNESS IOP TENNESSEE, LLC

MEDICARE: MIND BODY WELLNESS IOP TENNESSEE, LLC
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
2261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number : 1336867217
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIND BODY WELLNESS IOP TENNESSEE, LLC
Provider Business Mailing Address
First Line : 16 VILLAGE LN STE 200
Second Line :
City : COLLEYVILLE
State : TX
Zip : 76034-2948
Country : US
Telephone Number : 682-900-6631
Fax Number :
Provider Business Practice Location Address
First Line : 740 COOL SPRINGS BLVD STE 140
Second Line :
City : FRANKLIN
State : TN
Zip : 37067-6449
Country : US
Telephone Number : 469-991-7647
Fax Number : 682-477-3694
Authorized Official
Title or Position : VP, REV CYCLE MANAGEMENT
Name : BYRON MCLAUGHLIN
Credential :
Telephone Number : 682-350-5880
Provider Enumeration Date : 08/17/2022
Last Update Date : 05/13/2025

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