Provider Demographics
NPI:1003564048
Name:MIND BODY-EFT THERAPY PLLC
Entity Type:Organization
Organization Name:MIND BODY-EFT THERAPY PLLC
Other - Org Name:MIND BODY- EFT THEARPY PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LATTY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:989-274-4006
Mailing Address - Street 1:2438 GATESBORO DR W
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-3769
Mailing Address - Country:US
Mailing Address - Phone:989-274-4006
Mailing Address - Fax:
Practice Address - Street 1:2438 GATESBORO DR W
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3769
Practice Address - Country:US
Practice Address - Phone:989-274-4006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty