Provider Demographics
NPI:1205535226
Name:INBODIED
Entity type:Organization
Organization Name:INBODIED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:VICENTE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-S
Authorized Official - Phone:253-344-0769
Mailing Address - Street 1:216 QUENTIN DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-3730
Mailing Address - Country:US
Mailing Address - Phone:253-344-0769
Mailing Address - Fax:
Practice Address - Street 1:216 QUENTIN DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-3730
Practice Address - Country:US
Practice Address - Phone:253-344-0769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-28
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty