Provider Demographics
NPI:1184438350
Name:MIND BODY SOUL AND SPIRIT
Entity type:Organization
Organization Name:MIND BODY SOUL AND SPIRIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VERONA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, MSN, PMHNP
Authorized Official - Phone:321-244-7067
Mailing Address - Street 1:2269 HIALEAH ST NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-2650
Mailing Address - Country:US
Mailing Address - Phone:321-244-7067
Mailing Address - Fax:
Practice Address - Street 1:2269 HIALEAH ST NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-2650
Practice Address - Country:US
Practice Address - Phone:321-244-7067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty