Provider Demographics
NPI:1780256834
Name:M & M MIND AND BODY THERAPY
Entity type:Organization
Organization Name:M & M MIND AND BODY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MYLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:IVORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-612-7991
Mailing Address - Street 1:2080 WHITTAKER RD STE 164
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-8238
Mailing Address - Country:US
Mailing Address - Phone:734-612-7991
Mailing Address - Fax:
Practice Address - Street 1:2080 WHITTAKER RD STE 164
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-8238
Practice Address - Country:US
Practice Address - Phone:734-612-7991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty