Provider Demographics
NPI:1336867217
Name:MIND BODY WELLNESS IOP TENNESSEE, LLC
Entity type:Organization
Organization Name:MIND BODY WELLNESS IOP TENNESSEE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING & CONTRACTS SPECIALIS
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RINEHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-316-1856
Mailing Address - Street 1:16 VILLAGE LN STE 200
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-2948
Mailing Address - Country:US
Mailing Address - Phone:940-300-5077
Mailing Address - Fax:
Practice Address - Street 1:740 COOL SPRINGS BLVD STE 140
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6449
Practice Address - Country:US
Practice Address - Phone:469-991-7647
Practice Address - Fax:682-477-3694
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIND BODY WELLNESS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-17
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)