Organization
MINDBODYMOM, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMANTHA C RUSSELL PHD (CHIEF EXECUTIVE OFFICER)
(970) 471-3981
Entity
Organization
Contact information
Practice address
1636 W STEVANNA WAY, UNITED STATES, FLAGSTAFF, AZ 86001
(970) 471-3981
Mailing address
16192 COASTAL HWY, LEWES, DE 19958-3608
(970) 471-3981
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
2084P0800X
Psychiatry Physician
—
—
Other
Enumeration date
11/17/2025
Last updated
11/17/2025
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