Organization
MIND BODY AND SOUL A ROAD TO RECOVERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNN MCDONALD (CREDENTIALING SPECIALIST)
(219) 769-1670
Entity
Organization
Contact information
Practice address
5490 BROADWAY BSMT, MERRILLVILLE, IN 46410-1675
(219) 555-5555
Mailing address
5490 BROADWAY BSMT, MERRILLVILLE, IN 46410-1675
(219) 939-7763
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
06/02/2021
Last updated
06/07/2021
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