Provider Demographics
NPI:1265227276
Name:MIND-BODY LINK
Entity type:Organization
Organization Name:MIND-BODY LINK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMHC
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:631-530-1601
Mailing Address - Street 1:2847 ORCHID LN
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-7540
Mailing Address - Country:US
Mailing Address - Phone:631-530-1601
Mailing Address - Fax:
Practice Address - Street 1:2847 ORCHID LN
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-7540
Practice Address - Country:US
Practice Address - Phone:631-530-1601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)