Provider Demographics
NPI:1558721738
Name:MIND, BODY & BABY LLC
Entity Type:Organization
Organization Name:MIND, BODY & BABY LLC
Other - Org Name:ENCOMPASS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAITT
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:917-309-1618
Mailing Address - Street 1:5810 BISCAYNE BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-2639
Mailing Address - Country:US
Mailing Address - Phone:305-757-3441
Mailing Address - Fax:
Practice Address - Street 1:5810 BISCAYNE BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-2639
Practice Address - Country:US
Practice Address - Phone:305-757-3441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 1041C0700X
FLMT 3049106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty