Provider Demographics
NPI:1922988146
Name:THE BODYMIND, LLC
Entity type:Organization
Organization Name:THE BODYMIND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:LCP, LSCSW, LMT
Authorized Official - Phone:316-371-7226
Mailing Address - Street 1:654 N WOODCHUCK ST STE E
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-3571
Mailing Address - Country:US
Mailing Address - Phone:316-371-7226
Mailing Address - Fax:
Practice Address - Street 1:654 N WOODCHUCK ST STE E
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3571
Practice Address - Country:US
Practice Address - Phone:316-371-7226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30004696700001Medicaid