Provider Demographics
NPI:1861237752
Name:MIND BODY CONNECTION, LLC
Entity type:Organization
Organization Name:MIND BODY CONNECTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEO
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:207-612-1129
Mailing Address - Street 1:48 COURT ST
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-1864
Mailing Address - Country:US
Mailing Address - Phone:207-612-1129
Mailing Address - Fax:
Practice Address - Street 1:48 COURT ST
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-1864
Practice Address - Country:US
Practice Address - Phone:207-612-1129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-01
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health