Provider Demographics
NPI:1306477724
Name:EMPOWERING MIND AND BODY BALANCE, LLC
Entity type:Organization
Organization Name:EMPOWERING MIND AND BODY BALANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ALISON
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:314-333-2422
Mailing Address - Street 1:10057 1/2 TOELLE LN APT B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63137-3473
Mailing Address - Country:US
Mailing Address - Phone:314-333-2422
Mailing Address - Fax:
Practice Address - Street 1:10057 1/2 TOELLE LN APT B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63137-3473
Practice Address - Country:US
Practice Address - Phone:314-333-2422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-04
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty