Provider Demographics
NPI:1336956739
Name:MIND BODY WITH CORY
Entity type:Organization
Organization Name:MIND BODY WITH CORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS-BATTY
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:866-963-1128
Mailing Address - Street 1:PO BOX 18
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03036-0018
Mailing Address - Country:US
Mailing Address - Phone:866-963-1128
Mailing Address - Fax:
Practice Address - Street 1:4 VILLAGER RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NH
Practice Address - Zip Code:03036-4035
Practice Address - Country:US
Practice Address - Phone:866-963-1128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty