Mind Body Endurance LLC

Primary specialty

Exercise & Sports PsychologistTaxonomy code 103TE1100X

Legal business name

MIND BODY ENDURANCE LLC

Practice address

16 N Gore Ave Ste 204
Saint Louis, MO 63119-2315

Phone

(513) 505-2160

NPI assigned

Feb 10, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Riley Nickols, PHDNPI 1790019511

Title

Owner

Phone

(513) 505-2160

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mind Body Endurance LLC Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Riley Nickols

  • Psychologist
  • Saint Louis, MO
  • NPI 1790019511
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1675987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675987200000",
    "number": "1053018903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 N GORE AVE STE 204",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631192315",
            "telephone_number": "513-505-2160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 N GORE AVE STE 204",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631192315",
            "telephone_number": "513-505-2160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND BODY ENDURANCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-10",
        "last_updated": "2023-02-10",
        "certification_date": "2023-02-10",
        "status": "A",
        "authorized_official_last_name": "NICKOLS",
        "authorized_official_first_name": "RILEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "513-505-2160",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TE1100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Exercise & Sports",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1790019511",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mind Body Endurance LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Heun Min, MD
• Jing Juan Min, M.D.
• Mina Home Health Care LLC
• Albert Michael Mina, DMD
• Elena Minakova, MD
• Kenneth Minder
• Mindful Balance Emotional Health LLC
• Mindful Counseling LLC
• Mindful Solutions Counseling, LLC
• Mindful Way Therapy

• Psychologist in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Psychologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.