Provider Demographics
NPI:1710864996
Name:MIND BODY SOUL MARRIAGE AND FAMILY THERAPY PLLC
Entity type:Organization
Organization Name:MIND BODY SOUL MARRIAGE AND FAMILY THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CORTNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:929-260-0268
Mailing Address - Street 1:678 N COUNTRY RD UNIT 181
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-9096
Mailing Address - Country:US
Mailing Address - Phone:929-260-0268
Mailing Address - Fax:
Practice Address - Street 1:678 N COUNTRY RD UNIT 181
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-9096
Practice Address - Country:US
Practice Address - Phone:929-260-0268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty