Provider Demographics
NPI:1255181137
Name:MIND, BODY & SOUL INTEGRATIVE COUNSELING, LLC
Entity type:Organization
Organization Name:MIND, BODY & SOUL INTEGRATIVE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-480-1612
Mailing Address - Street 1:1913 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-4223
Mailing Address - Country:US
Mailing Address - Phone:515-480-1612
Mailing Address - Fax:
Practice Address - Street 1:1913 GRAND AVE
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-4223
Practice Address - Country:US
Practice Address - Phone:515-726-9166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)