Provider Demographics
NPI:1386959922
Name:MIND & BODY THERAPIES, PC
Entity type:Organization
Organization Name:MIND & BODY THERAPIES, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:360-696-2744
Mailing Address - Street 1:200 E 22ND ST
Mailing Address - Street 2:STE E
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-3266
Mailing Address - Country:US
Mailing Address - Phone:360-696-2744
Mailing Address - Fax:360-696-4811
Practice Address - Street 1:200 E 22ND ST
Practice Address - Street 2:STE E
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3266
Practice Address - Country:US
Practice Address - Phone:360-696-2744
Practice Address - Fax:360-696-4811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 2523261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB 23350Medicare PIN
1104877604Medicare UPIN