Provider Demographics
NPI:1720238439
Name:BODYMIND CONNECTIONS LLC
Entity type:Organization
Organization Name:BODYMIND CONNECTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:RACHAEL
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:573-442-5475
Mailing Address - Street 1:409 VANDIVER DR
Mailing Address - Street 2:BLDG 6 SUITE 104
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-3754
Mailing Address - Country:US
Mailing Address - Phone:573-442-5475
Mailing Address - Fax:573-442-5145
Practice Address - Street 1:409 VANDIVER DR
Practice Address - Street 2:BLDG 6 SUITE 104
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-3754
Practice Address - Country:US
Practice Address - Phone:573-442-5475
Practice Address - Fax:573-442-5145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0029301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO493553853Medicaid
MO493553853Medicaid