Provider Demographics
NPI:1124685037
Name:MIND BODY CONNECTIONS LLC
Entity type:Organization
Organization Name:MIND BODY CONNECTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC-S/ OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:956-250-2373
Mailing Address - Street 1:PO BOX 4125
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78540-4125
Mailing Address - Country:US
Mailing Address - Phone:956-250-2373
Mailing Address - Fax:956-524-5642
Practice Address - Street 1:5415 N MCCOLL RD STE 103
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4664
Practice Address - Country:US
Practice Address - Phone:956-250-2373
Practice Address - Fax:956-524-5642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-26
Last Update Date:2019-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty