Provider Demographics
NPI:1285102939
Name:BODY AND SPIRIT WELLNESS
Entity type:Organization
Organization Name:BODY AND SPIRIT WELLNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:714-606-8185
Mailing Address - Street 1:PO BOX 6464
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-0464
Mailing Address - Country:US
Mailing Address - Phone:714-606-8185
Mailing Address - Fax:949-932-0901
Practice Address - Street 1:980 W 17TH ST STE C
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-3554
Practice Address - Country:US
Practice Address - Phone:714-606-8185
Practice Address - Fax:949-932-0901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-09
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health