Organization
MINDBODYSOULWORKS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY RUDOLPH BSN, RN, LCSW (THERAPIST/OWNER)
(814) 616-2858
Entity
Organization
Contact information
Practice address
4190 E LAKE RD, ERIE, PA 16511-1355
(814) 616-2858
(814) 616-2860
Mailing address
4190 E LAKE RD, ERIE, PA 16511-1355
(814) 616-2858
(814) 616-2860
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
01/09/2019
Last updated
01/09/2019
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