Provider Demographics
NPI:1598037400
Name:MIND/BODY HEALTH & PSYCHOLOGY LLC
Entity Type:Organization
Organization Name:MIND/BODY HEALTH & PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEENA
Authorized Official - Middle Name:MYONG
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:340-626-8106
Mailing Address - Street 1:PO BOX 12137
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00801-5137
Mailing Address - Country:US
Mailing Address - Phone:340-626-8106
Mailing Address - Fax:
Practice Address - Street 1:6115 ESTATE SMITH BAY
Practice Address - Street 2:SUITE 334 & 335
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-1324
Practice Address - Country:US
Practice Address - Phone:340-626-8106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI10-029 PSY251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health