Provider Demographics
NPI:1154147601
Name:ELITE MIND AND BODY WELLNESS: MENTAL HEALTH AND PRIMARY CARE SERVICES,
Entity type:Organization
Organization Name:ELITE MIND AND BODY WELLNESS: MENTAL HEALTH AND PRIMARY CARE SERVICES,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:MS
Authorized Official - First Name:MARYBETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:PIRRONE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP, PMHNP-C
Authorized Official - Phone:575-644-6367
Mailing Address - Street 1:519 SHILOH RD
Mailing Address - Street 2:
Mailing Address - City:MESILLA PARK
Mailing Address - State:NM
Mailing Address - Zip Code:88047-9745
Mailing Address - Country:US
Mailing Address - Phone:575-644-6367
Mailing Address - Fax:
Practice Address - Street 1:519 SHILOH RD
Practice Address - Street 2:
Practice Address - City:MESILLA PARK
Practice Address - State:NM
Practice Address - Zip Code:88047-9745
Practice Address - Country:US
Practice Address - Phone:575-644-6367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty