Provider Demographics
NPI:1790304780
Name:MIND & BODY SYNERGY CENTER
Entity Type:Organization
Organization Name:MIND & BODY SYNERGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GOSSARD
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, LICDC
Authorized Official - Phone:419-315-6422
Mailing Address - Street 1:12753 LULU RD
Mailing Address - Street 2:
Mailing Address - City:IDA
Mailing Address - State:MI
Mailing Address - Zip Code:48140-9524
Mailing Address - Country:US
Mailing Address - Phone:419-315-6422
Mailing Address - Fax:
Practice Address - Street 1:333 W WOOSTER ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2807
Practice Address - Country:US
Practice Address - Phone:419-315-6422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty