Provider Demographics
NPI:1346882834
Name:MIND BODY AND SOUL PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:MIND BODY AND SOUL PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVERETTE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:810-391-9047
Mailing Address - Street 1:6375 E TANQUE VERDE RD STE 140
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-3863
Mailing Address - Country:US
Mailing Address - Phone:520-885-4679
Mailing Address - Fax:
Practice Address - Street 1:6375 E TANQUE VERDE RD STE 140
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3863
Practice Address - Country:US
Practice Address - Phone:520-885-4679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty