Mindbody Wellness, LLC

NPI #1992971675 in Aurora, Missouri

Provider Information

NPI Number: 1992971675
Entity Type: Organization
Organization Name: Mindbody Wellness, LLC
Primary Specialty: Psychologist - Clinical
Enumeration Date: May 2, 2008
Last Updated: May 2, 2008

Practice Location

Address: 1407 S ELLIOTT AVE
Address 2: SUITE B
City: Aurora
State: Missouri
ZIP Code: 65605-2103
Phone: (417) 440-0826

Authorized Official

Name: DR. STACEY L. WILLIS-CENTER, PH.D.
Title: CLINICAL PSYCHOLOGIST
Phone: (417) 440-0826

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychologist - Clinical — Clinical	103TC0700X	Primary

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