Provider Demographics
NPI:1023602034
Name:MINDBODY COUNSELING
Entity type:Organization
Organization Name:MINDBODY COUNSELING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:CLAY
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:269-330-4695
Mailing Address - Street 1:400 S ROSE ST APT 401
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5231
Mailing Address - Country:US
Mailing Address - Phone:269-330-4695
Mailing Address - Fax:
Practice Address - Street 1:400 S ROSE ST APT 401
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5231
Practice Address - Country:US
Practice Address - Phone:269-330-4695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-22
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty