Provider Demographics
NPI:1396112157
Name:MIND BODY PSYCHOLOGY SERVICES LLC
Entity type:Organization
Organization Name:MIND BODY PSYCHOLOGY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMALHEISER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-829-2975
Mailing Address - Street 1:4600 MILITARY TRL STE 103
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-4811
Mailing Address - Country:US
Mailing Address - Phone:561-249-7400
Mailing Address - Fax:
Practice Address - Street 1:4600 MILITARY TRL STE 103
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4811
Practice Address - Country:US
Practice Address - Phone:561-249-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 9109103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty