Organization
MIND BODY & HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VANESSA REYES CMA (PRACTICE MANAGER)
(440) 364-4741
Entity
Organization
Contact information
Practice address
349 CENTER ST, ASHTABULA, OH 44004-6901
(440) 812-7108
Mailing address
349 CENTER ST, ASHTABULA, OH 44004-6901
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0477297
—
OH
05
—
3090711
—
OH
01
—
900170792
PRIORITY HEALTH - VENDOR NUMBER
—
01
—
NP11405
STATE LICENSE
—
Enumeration date
11/19/2021
Last updated
01/30/2024
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