MIND AND BODY WELLNESS CLINIC (NPI# 1063048668) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063048668 |
| Entity Type | Organization |
| Organization Name | MIND AND BODY WELLNESS CLINIC |
| Practice Address |
1176 Vickery Ln Ste 100 Cordova TN 38016-0631 |
| Practice Telephone | 9017371992 |
| Mailing Telephone | 9017371992 |
| Mailing Fax Number | 9013098784 |
| Enumeration Date | 2020-03-16 |
| Last Update Date | 2020-03-16 |
| Authorized Official Name | TONYA M MALADY (CREDENTIALING) |
| Authorized Official Telephone | 9017371992 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | LICENSE | 44725 | 01 |
| Street Address |
1176 VICKERY LN STE 100 |
| City | CORDOVA |
| State | TN |
| Zip Code | 38016-0631 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235247958 | Usha B Swamy | Psychiatry & Neurology | 1176 Vickery Ln Ste 100, Cordova, TN 38016 | 2006-08-25 |
| 1992043749 | Precision Mental Health LLP | Psychiatry & Neurology | 1176 Vickery Ln Ste 100, Cordova, TN 38016-0631 | 2013-01-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548886872 | Megan Scott Bolton | Physical Therapist | 8110 Cordova Road Suite 107, Cordova, TN 38016 | 2020-06-23 |
| 1477195451 | Jacqueline Reeves Thomas | Counselor | Memphis Veterans Affairs Medical Center (vamc), 1030 Jefferson Ave, Memphis, TN 38016 | 2019-10-11 |
| 1376195842 | Robert Cody Heismann | Physical Therapist | 8110 Cordova Rd, Ste 107, Cordova, TN 38016 | 2019-07-15 |
| 1881189702 | Carolyn Bean | Home Health Aide | 1786 Beaver Trail Dr, Cordova, TN 38016 | 2018-06-22 |
| 1255776886 | Suzanne Elaine Baker | Family Medicine | 2257 North Germantown Parkway, Memphis, TN 38016 | 2013-05-09 |
| 1487806683 | Janet Lee Ferrell | Counselor | 1340 Siskin Drive, Cordova, TN 38016 | 2008-10-21 |
| 1114186624 | Rebecca L Bills | Optometrist | 1795 N Germantown Pkwy, Cordova, TN 38016 | 2008-06-09 |
| 1679784128 | Linda Kay Yates | Emergency Medicine | 1401 Dexter Lane, Cordova, TN 38016 | 2007-05-25 |
| 1417168386 | Healthquest | Psychiatry & Neurology | 58 Timber Creek, Cordova, TN 38016 | 2007-05-24 |
| 1114079795 | Barbara T Henking | Psychologist | 8134 Country Village, #102, Cordova, TN 38016 | 2007-01-17 |
| Find all providers in zip 38016 | ||||
| Taxonomy Code | 2084P0804X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Child & Adolescent Psychiatry |
| 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. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407963515 | Constance L Durbin | Psychiatry & Neurology | 1135 Cully Rd, Ste 100, Cordova, TN 38016 | 2006-08-24 |
| 1487828828 | Elizabeth Ann Vannucci | Psychiatry & Neurology | 1135 Cully Rd, Cordova, TN 38018-8503 | 2008-04-16 |
| 1588769442 | Child & Adolescent Psychiatry Associates | Psychiatry & Neurology | 1135 Cully Rd, #100, Cordova, TN 38016 | 2006-09-14 |
| 1124043161 | Leslie Eugene Smith Jr. | Psychiatry & Neurology | 1540 Appling Care Ln, #100, Cordova, TN 38016-4957 | 2006-07-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457959017 | Periscope Community Health Services | Psychiatry & Neurology | 167 Belle Forest Cir, Nashville, TN 37221-2103 | 2020-10-15 |
| 1902117815 | The Family Wellness Center, LLC | Psychiatry & Neurology | 7503 Queens Ct, Suite 1, Germantown, TN 38138-3875 | 2010-06-24 |
| 1295053767 | Annie Naik Gadiparthi | Psychiatry & Neurology | 848 Adams Avenue L400, Memphis, TN 38103-8503 | 2010-05-09 |
| 1063739415 | Wellsprings Psychiatry and Counseling Center, Pllc | Psychiatry & Neurology | 109 Holiday Ct Ste D10, Franklin, TN 37067-1311 | 2010-04-26 |
| 1619154440 | 17th Avenue Psychiatry | Psychiatry & Neurology | 1503 17th Ave S, Nashville, TN 37212-2805 | 2008-01-23 |
| 1093913576 | Michael Greer Md PC | Psychiatry & Neurology | 183 Fiddlers Ln, Kingston, TN 37763-4020 | 2007-07-06 |
| 1669579116 | Jonathan David Shaw | Psychiatry & Neurology | 2911 Brunswick Road, Memphis, TN 38133 | 2006-09-19 |
| 1609971134 | Richard A Colletti | Psychiatry & Neurology | 109 Holiday Ct., D10, Franklin, TN 37067 | 2006-09-13 |
| 1558380089 | Daniel Barton | Psychiatry & Neurology | 4535 Harding Pike, Suite # 102, Nashville, TN 37205-2120 | 2006-07-18 |
| 1760485866 | Paul David Clein | Psychiatry & Neurology | 2911 Brunswick Rd, Lakeside Hospital, Memphis, TN 38133 | 2005-05-23 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.