Provider Demographics
NPI:1932419413
Name:MIND BODY SOULUTIONS
Entity Type:Organization
Organization Name:MIND BODY SOULUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SOLLIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:262-327-6381
Mailing Address - Street 1:12802 W HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:WI
Mailing Address - Zip Code:53007-1606
Mailing Address - Country:US
Mailing Address - Phone:262-327-6381
Mailing Address - Fax:
Practice Address - Street 1:12802 W HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:WI
Practice Address - Zip Code:53007-1606
Practice Address - Country:US
Practice Address - Phone:262-327-6381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Multi-Specialty
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty