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Contact Information

MIND BODY ENDURANCE LLC
16 N GORE AVE STE 204
SAINT LOUIS, MO63119-2315
 Phone: 513-505-2160
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Exercise & Sports

103TE1100X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for MIND BODY ENDURANCE LLC · (Female)

NPI Number 1053018903
Status Active
Credentials
Entity Individual
Enumeration date 02/10/2023
Last updated 02/10/2023 - About 3 years ago
Sole proprietor 1 Not specified
Identifiers
  • MO Medicaid 1790019511
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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