Provider Demographics
NPI:1639980808
Name:HEALING MIND BODY AND SOUL PLLC
Entity type:Organization
Organization Name:HEALING MIND BODY AND SOUL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BUKOLA
Authorized Official - Middle Name:O
Authorized Official - Last Name:KUTI
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:651-230-1900
Mailing Address - Street 1:4265 CORN SILK LN
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-2213
Mailing Address - Country:US
Mailing Address - Phone:651-230-1900
Mailing Address - Fax:
Practice Address - Street 1:4265 CORN SILK LN
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55129-2213
Practice Address - Country:US
Practice Address - Phone:651-230-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)