| NPI | 1730959818 |
|---|---|
| Other Name | MIND BODY OPTIMIZATION - SOUTHLAKE IOP |
| Entity Type | Organization |
| Authorized Contact | MICHELLE LEE RINEHART Credentialing & Contracts Specialis 682-316-1856 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2024-01-08 |
| Last Update Date | 2024-11-21 |