Organization
MIND BODY ENDURANCE LLC
Active
Other names
Mind Body Endurance LLC
Organization subpart
No
Provider details
NPI number
Authorized official
RILEY NICKOLS PHD (OWNER)
(513) 505-2160
Entity
Organization
Contact information
Practice address
16 N GORE AVE STE 204, SAINT LOUIS, MO 63119-2315
(513) 505-2160
Mailing address
16 N GORE AVE STE 204, SAINT LOUIS, MO 63119-2315
(513) 505-2160
Taxonomy
Speciality
Code
Description
License number
State
103TE1100X
Exercise & Sports Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790019511
—
MO
Enumeration date
02/10/2023
Last updated
02/10/2023
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