Provider Demographics
NPI:1811659584
Name:MIND AND BODY INTEGRATION, PLLC
Entity type:Organization
Organization Name:MIND AND BODY INTEGRATION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DNP, FNP-BC, PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEIBLI
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:719-430-5650
Mailing Address - Street 1:265 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PENROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81240-9312
Mailing Address - Country:US
Mailing Address - Phone:719-430-5650
Mailing Address - Fax:719-345-0607
Practice Address - Street 1:109 LATIGO LN STE G
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-8113
Practice Address - Country:US
Practice Address - Phone:719-430-5650
Practice Address - Fax:719-345-0607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-11
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty