Provider Demographics
NPI:1871302836
Name:MIND BODY SOUL ALIGNED LLC
Entity type:Organization
Organization Name:MIND BODY SOUL ALIGNED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHELSIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC
Authorized Official - Phone:505-381-5301
Mailing Address - Street 1:300 JOYA LOOP
Mailing Address - Street 2:
Mailing Address - City:WHITE ROCK
Mailing Address - State:NM
Mailing Address - Zip Code:87547-3707
Mailing Address - Country:US
Mailing Address - Phone:605-360-8918
Mailing Address - Fax:
Practice Address - Street 1:127 EASTGATE DR STE B201
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-3300
Practice Address - Country:US
Practice Address - Phone:505-381-5301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-04
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)