Provider Demographics
NPI:1093336505
Name:MIND BODY THERAPEUTICS LLC
Entity Type:Organization
Organization Name:MIND BODY THERAPEUTICS LLC
Other - Org Name:CENTER FOR THE HEALING ARTS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:B
Authorized Official - Last Name:STATLANDER-SLOTE
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:305-331-4489
Mailing Address - Street 1:2630 SE WILLOUGHBY BLVD STE 2B
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4700
Mailing Address - Country:US
Mailing Address - Phone:954-303-8558
Mailing Address - Fax:
Practice Address - Street 1:2630 SE WILLOUGHBY BLVD STE 2B
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4700
Practice Address - Country:US
Practice Address - Phone:954-303-8558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-06
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty