Provider Demographics
NPI:1447068309
Name:MIND BODY OPTIMIZATION TENNESSEE, L.L.C.
Entity type:Organization
Organization Name:MIND BODY OPTIMIZATION TENNESSEE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:REECE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:682-477-3705
Mailing Address - Street 1:16 VILLAGE LN STE 200
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-2948
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:740 COOL SPRINGS BLVD STE 140
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6449
Practice Address - Country:US
Practice Address - Phone:615-234-9606
Practice Address - Fax:615-278-3555
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIND BODY OPTIMIZATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-24
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty