Provider Demographics
NPI:1063144392
Name:MIND BODY AND SOUL THERAPEUTIC SERVICES LLC
Entity type:Organization
Organization Name:MIND BODY AND SOUL THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MESSINA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:501-547-9273
Mailing Address - Street 1:835 CENTRAL AVE STE 512
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-5310
Mailing Address - Country:US
Mailing Address - Phone:501-547-9273
Mailing Address - Fax:
Practice Address - Street 1:835 CENTRAL AVE STE 512
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-5310
Practice Address - Country:US
Practice Address - Phone:501-547-9273
Practice Address - Fax:501-547-3817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-27
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health