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NPI Code Detail

MEDICARE: MIND BODY CONNECTION HEALTH AND WELLNESS LLC

MEDICARE: MIND BODY CONNECTION HEALTH AND WELLNESS 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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number : 1891433579
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIND BODY CONNECTION HEALTH AND WELLNESS LLC
Provider Business Mailing Address
First Line : 1525 S HIGLEY RD
Second Line :
City : GILBERT
State : AZ
Zip : 85296-4795
Country : US
Telephone Number : 888-509-2113
Fax Number : 888-234-8102
Provider Business Practice Location Address
First Line : 1525 S HIGLEY RD STE 104
Second Line :
City : GILBERT
State : AZ
Zip : 85296-5045
Country : US
Telephone Number : 888-509-2113
Fax Number : 888-234-8102
Authorized Official
Title or Position : OWNER
Name : MS. LASHAUN PERRY
Credential : PMHNP-BC
Telephone Number : 888-509-2113
Provider Enumeration Date : 05/23/2022
Last Update Date : 01/08/2024

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Directions to “MIND BODY CONNECTION HEALTH AND WELLNESS LLC ” Practice Location

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