Mindbodymom, Inc.

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

MINDBODYMOM, INC.

Practice address

1636 W Stevanna Way
United States
Flagstaff, AZ 86001

Phone

(970) 471-3981

NPI assigned

Nov 17, 2025

Organization subpart

No

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

Authorized official

Name

Dr. Samantha C Russell, PHDNPI 1780204404

Title

Chief Executive Officer

Phone

(970) 471-3981

Specialties & licenses 2

Addresses

Practitioners 1

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

• Samantha C Russell

  • Clinical Psychologist
  • Albuquerque, NM
  • NPI 1780204404
  NPD Authorized official

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

{
    "created_epoch": "1763337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763337600000",
    "number": "1538029988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16192 COASTAL HWY",
            "city": "LEWES",
            "state": "DE",
            "postal_code": "199583608",
            "telephone_number": "970-471-3981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1636 W STEVANNA WAY",
            "address_2": "UNITED STATES",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "86001",
            "telephone_number": "970-471-3981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDBODYMOM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-11-17",
        "last_updated": "2025-11-17",
        "certification_date": "2025-11-01",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "970-471-3981",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Mary Mills, M. ED.
• Gabrielle Taylor Mills
• Gail Mills, MA
• Jessica M Mills, DNP, PMHNP-BC
• Gary Dennis Milton, DDS
• Brianna Marie Miner, MD
• Hannah Miner, PA
• Kimberly Shumway Miner, MSW
• Joan C Mitrius, M.D.
• Eugene Richard Moan, ED.D.

• Psychologist in Flagstaff, AZ
• Providers in Flagstaff, AZ by specialty
• Psychologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2025; 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.