Provider Demographics
NPI:1952102717
Name:THE MIND BODY SOUL COLLECTIVE LLC
Entity type:Organization
Organization Name:THE MIND BODY SOUL COLLECTIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-217-2125
Mailing Address - Street 1:6410 S 32ND ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4677
Mailing Address - Country:US
Mailing Address - Phone:402-217-2125
Mailing Address - Fax:
Practice Address - Street 1:3201 PIONEERS BLVD STE 306
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-5963
Practice Address - Country:US
Practice Address - Phone:402-217-2125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty