Provider Demographics
NPI:1184207748
Name:MIND BODY & SOULUTIONS
Entity Type:Organization
Organization Name:MIND BODY & SOULUTIONS
Other - Org Name:MIND BODY & SOULUTIONS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIZZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-246-9768
Mailing Address - Street 1:PO BOX 15954
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15244-0954
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1002 GREENTREE RD STE 107
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-3226
Practice Address - Country:US
Practice Address - Phone:412-246-9768
Practice Address - Fax:855-272-9757
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIND BODY & SOULUTIONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-03
Last Update Date:2021-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty