MIND AND BODY WELLNESS CLINIC NPI 1063048668

NPI Information

  • NPI: 1063048668
  • Provider Name: MIND AND BODY WELLNESS CLINIC
  • Classification: Psychiatry & Neurology - 2084P0804X
  • Specialization: Child & Adolescent Psychiatry
  • Entity Type: Organization
  • Address: 1176 VICKERY LN STE 100
    CORDOVA, TN
    ZIP 38016
  • Phone: (901) 737-1992

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NPI Details

MIND AND BODY WELLNESS CLINIC is a child and adolescent psychiatry psychiatry neurology in Cordova, TN. The provider is child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. MIND AND BODY WELLNESS CLINIC NPI is 1063048668. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1176 VICKERY LN STE 100
CORDOVA, TN
ZIP 38016-631
Phone: (901) 737-1992

The provider's authorized official is Tonya M Malady .
The authorized official title is Credentialing and has the following contact phone number (901) 737-1992.

The enumeration date for this NPI number is 3/16/2020 and was last updated on 3/16/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12084P0804XPsychiatry & NeurologyChild & Adolescent PsychiatryYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
144725OTHERTENNESSEELICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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