Provider Demographics
NPI:1508696303
Name:INHABIT BODYMIND THERAPY
Entity type:Organization
Organization Name:INHABIT BODYMIND THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA 'SHURA'
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:EAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:458-215-1356
Mailing Address - Street 1:872 GROVE RD STE UR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-6300
Mailing Address - Country:US
Mailing Address - Phone:458-215-1356
Mailing Address - Fax:
Practice Address - Street 1:872 GROVE RD STE UR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-6300
Practice Address - Country:US
Practice Address - Phone:458-215-1356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty