Provider Demographics
NPI:1992262091
Name:MIND & BODY GARDEN, A PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:MIND & BODY GARDEN, A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YISHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:XU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:619-933-2591
Mailing Address - Street 1:885 N SAN ANTONIO RD STE O
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1341
Mailing Address - Country:US
Mailing Address - Phone:650-434-2563
Mailing Address - Fax:833-259-3486
Practice Address - Street 1:885 N SAN ANTONIO RD STE O
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1341
Practice Address - Country:US
Practice Address - Phone:650-434-2563
Practice Address - Fax:833-259-3486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-25
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty