Mind Body Splendid Sun

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

MIND BODY SPLENDID SUN

Practice address

185 Montreal Way
Falling Waters, WV 25419-0109

Phone

(681) 242-3799

NPI assigned

Jan 22, 2025

Organization subpart

No

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

Authorized official

Name

Micheal Lee

Title

Manager Credentialing

Phone

(786) 791-7529

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Practitioners 1

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

• Rachel Matthews, LCSW-C

  • Clinical Social Worker
  • Falling Waters, WV
  • NPI 1063126183

  Clinical, MD

  Medicare reassignment NPD

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

{
    "created_epoch": "1737504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738454400000",
    "number": "1104638519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MIDDLETOWN PKWY UNIT 202",
            "city": "MIDDLETOWN",
            "state": "MD",
            "postal_code": "217697767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 MONTREAL WAY",
            "city": "FALLING WATERS",
            "state": "WV",
            "postal_code": "254190109",
            "telephone_number": "681-242-3799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND BODY SPLENDID SUN",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-22",
        "last_updated": "2025-02-02",
        "certification_date": "2025-02-02",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "MICHEAL",
        "authorized_official_title_or_position": "MANAGER CREDENTIALING",
        "authorized_official_telephone_number": "786-791-7529"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Calvin Martin Jr.
• Michele Martin
• Rachel Matthews, LCSW-C
• Tonya McClure
• Kimber Suzanne Middleton
• Christopher Mouser
• Kimberley Nicewarner
• Robert Nicoletti
• Rachel Page, RD
• Tracey Christine Parks

• All providers in Falling Waters, WV
• Clinical Social Worker in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.