Provider Demographics
NPI:1164804977
Name:BODY MIND SPIRIT THERAPY CENTER
Entity Type:Organization
Organization Name:BODY MIND SPIRIT THERAPY CENTER
Other - Org Name:THINK SWEET, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:PIERCE
Authorized Official - Last Name:PINEDA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:561-727-6858
Mailing Address - Street 1:1045 EAST ATLANTIC AVENUE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483
Mailing Address - Country:US
Mailing Address - Phone:561-727-6858
Mailing Address - Fax:561-330-4264
Practice Address - Street 1:1045 EAST ATLANTIC AVENUE
Practice Address - Street 2:SUITE 205
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483
Practice Address - Country:US
Practice Address - Phone:561-727-6858
Practice Address - Fax:561-330-4264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1988106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL766173800Medicaid