Provider Demographics
NPI:1689864571
Name:MIND BODY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:MIND BODY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIMONS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:941-377-8111
Mailing Address - Street 1:5436 FRUITVILLE RD # 150
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6403
Mailing Address - Country:US
Mailing Address - Phone:941-377-8111
Mailing Address - Fax:941-377-8778
Practice Address - Street 1:1869 PORTER LAKE DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-7893
Practice Address - Country:US
Practice Address - Phone:941-377-8111
Practice Address - Fax:941-377-8778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4716251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health