Provider Demographics
NPI:1902057797
Name:MIND BODY SPIRIT CENTER
Entity Type:Organization
Organization Name:MIND BODY SPIRIT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWINSKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-625-2660
Mailing Address - Street 1:160 WAYNESBOROUGH WAY
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-6457
Mailing Address - Country:US
Mailing Address - Phone:507-625-2660
Mailing Address - Fax:
Practice Address - Street 1:160 WAYNESBOROUGH WAY
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6457
Practice Address - Country:US
Practice Address - Phone:507-625-2660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3920103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1975170-00Medicaid
MN125732OtherUCARE
MN45Q33L0OtherBLUE CROSS BLUE SHEILD
MN62-51173OtherMEDICA