Provider Demographics
NPI:1770384240
Name:MIND-BODY RENEWAL THERAPY SERVICES LLC
Entity type:Organization
Organization Name:MIND-BODY RENEWAL THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-549-6793
Mailing Address - Street 1:3069 ALPINE TER APT 14B
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-2941
Mailing Address - Country:US
Mailing Address - Phone:937-478-3486
Mailing Address - Fax:
Practice Address - Street 1:8118 CORPORATE WAY STE 175
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-7504
Practice Address - Country:US
Practice Address - Phone:513-549-6793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty