Provider Demographics
NPI:1942682737
Name:MIND, BODY & SOUL, INC.
Entity Type:Organization
Organization Name:MIND, BODY & SOUL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC/MSW
Authorized Official - Phone:210-551-8244
Mailing Address - Street 1:6039 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78244-1689
Mailing Address - Country:US
Mailing Address - Phone:210-551-8244
Mailing Address - Fax:210-263-9765
Practice Address - Street 1:1139 GEMBLER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78219-3224
Practice Address - Country:US
Practice Address - Phone:210-551-8244
Practice Address - Fax:210-263-9765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10715305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization