# MIND BODY SOUL WELLNESS, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902733165
- **Authorized official:** DR. LETATIA R VANCE (DIRECTOR)
- **Authorized official phone:** (318) 658-7428

## Contact information

- **Practice address:** 3818 JOSEPH RANDALL DR, SHREVEPORT, LA 71107-3149
- **Practice address phone:** (318) 658-7428
- **Practice address fax:** (318) 370-3674
- **Mailing address:** 3818 JOSEPH RANDALL DR, SHREVEPORT, LA 71107-3149
- **Mailing address phone:** (318) 658-7428
- **Mailing address fax:** (318) 370-3674

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171400000X | Health & Wellness Coach | — | NULL | Yes |
| 171400000X | Health & Wellness Coach | — | — | Yes |

## Other

- **Enumeration date:** 05/04/2026
- **Last updated:** 05/04/2026