Provider Demographics
NPI:1205495496
Name:MIND & SOUL TELEWELLNESS LLC
Entity type:Organization
Organization Name:MIND & SOUL TELEWELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-953-8922
Mailing Address - Street 1:320 E TOWSONTOWN BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5331
Mailing Address - Country:US
Mailing Address - Phone:443-953-8922
Mailing Address - Fax:855-955-1334
Practice Address - Street 1:320 E TOWSONTOWN BLVD STE 201
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5331
Practice Address - Country:US
Practice Address - Phone:443-953-8922
Practice Address - Fax:855-955-1334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-11
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty