Provider Demographics
NPI:1578609194
Name:MIND-BODY HEALTH PROFESSIONALS, P.A.
Entity Type:Organization
Organization Name:MIND-BODY HEALTH PROFESSIONALS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-345-0060
Mailing Address - Street 1:10875 GRANDVIEW
Mailing Address - Street 2:BLDG. 22, SUITE 2200
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1510
Mailing Address - Country:US
Mailing Address - Phone:913-345-0060
Mailing Address - Fax:913-345-0090
Practice Address - Street 1:10875 GRANDVIEW
Practice Address - Street 2:BLDG. 22, SUITE 2200
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1510
Practice Address - Country:US
Practice Address - Phone:913-345-0060
Practice Address - Fax:913-345-0090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4-18723101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS069702Medicare ID - Type UnspecifiedMSW, LSCSW
KS161349Medicare ID - Type UnspecifiedARNP
KS102451Medicare ID - Type UnspecifiedMD