Provider Demographics
NPI:1700656873
Name:MBOC TEXAS, PLLC
Entity Type:Organization
Organization Name:MBOC TEXAS, PLLC
Other - Org Name:MIND BODY OPTIMIZATION - SOUTHLAKE
Other - Org Type:Other Name
Authorized Official - Title/Position:CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-300-5077
Mailing Address - Street 1:16 VILLAGE LN STE 200
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-2948
Mailing Address - Country:US
Mailing Address - Phone:940-300-5077
Mailing Address - Fax:
Practice Address - Street 1:271 W SOUTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-7049
Practice Address - Country:US
Practice Address - Phone:469-990-3626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)