Provider Demographics
NPI:1689198715
Name:MIND AND BODY INTEGRATIVE HEALING CENTER
Entity Type:Organization
Organization Name:MIND AND BODY INTEGRATIVE HEALING CENTER
Other - Org Name:INTEGRATIVE HEALING CENTERS OF UTAH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WATTSON
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-590-8129
Mailing Address - Street 1:1935 W 4700 S STE 330
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-1105
Mailing Address - Country:US
Mailing Address - Phone:801-590-8129
Mailing Address - Fax:801-905-1258
Practice Address - Street 1:2860 W 4700 S STE B
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-2159
Practice Address - Country:US
Practice Address - Phone:801-590-8129
Practice Address - Fax:801-905-1258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-31
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty