Provider Demographics
NPI:1134789563
Name:MIND, BODY & SPIRIT MARRIAGE AND FAMILY THERAPY
Entity type:Organization
Organization Name:MIND, BODY & SPIRIT MARRIAGE AND FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:315-243-1083
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13201-0186
Mailing Address - Country:US
Mailing Address - Phone:315-243-1083
Mailing Address - Fax:
Practice Address - Street 1:159 FOREST HILL DR
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206-2807
Practice Address - Country:US
Practice Address - Phone:315-243-1083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-18
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty