Provider Demographics
NPI:1972124352
Name:MINDBODYHEART PATHWAYS PLLC.
Entity Type:Organization
Organization Name:MINDBODYHEART PATHWAYS PLLC.
Other - Org Name:MINDBODYHEART PSYCHIATRY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER AND DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-417-6213
Mailing Address - Street 1:47392 272ND ST STE 3
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:SD
Mailing Address - Zip Code:57032-8304
Mailing Address - Country:US
Mailing Address - Phone:773-552-9688
Mailing Address - Fax:
Practice Address - Street 1:47392 272ND ST STE 3
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:SD
Practice Address - Zip Code:57032-8304
Practice Address - Country:US
Practice Address - Phone:773-417-6213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-27
Last Update Date:2023-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty