Provider Demographics
NPI:1083354914
Name:THE MIND BODY COLLABORATIVE
Entity Type:Organization
Organization Name:THE MIND BODY COLLABORATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER/CO-FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:CONKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:737-256-7801
Mailing Address - Street 1:3811 BEE CAVES RD STE 204
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6459
Mailing Address - Country:US
Mailing Address - Phone:737-256-7801
Mailing Address - Fax:
Practice Address - Street 1:3811 BEE CAVES RD STE 204
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6459
Practice Address - Country:US
Practice Address - Phone:737-256-7801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health