Provider Demographics
NPI:1891433579
Name:MIND BODY CONNECTION HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:MIND BODY CONNECTION HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LASHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:888-509-2113
Mailing Address - Street 1:1525 S HIGLEY RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-4795
Mailing Address - Country:US
Mailing Address - Phone:888-509-2113
Mailing Address - Fax:888-234-8102
Practice Address - Street 1:1525 S HIGLEY RD STE 104
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-5045
Practice Address - Country:US
Practice Address - Phone:888-509-2113
Practice Address - Fax:888-234-8102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-23
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty