Provider Demographics
NPI:1629816285
Name:MIND BODY PSYCHIATRIC LLC
Entity type:Organization
Organization Name:MIND BODY PSYCHIATRIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN, PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:UNSELD
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:605-933-9715
Mailing Address - Street 1:1120 6TH CORSO
Mailing Address - Street 2:
Mailing Address - City:NEBRASKA CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68410-2747
Mailing Address - Country:US
Mailing Address - Phone:402-713-0110
Mailing Address - Fax:
Practice Address - Street 1:1120 6TH CORSO
Practice Address - Street 2:
Practice Address - City:NEBRASKA CITY
Practice Address - State:NE
Practice Address - Zip Code:68410-2747
Practice Address - Country:US
Practice Address - Phone:402-713-0110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-17
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty