Mind Body Wellness PC

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

MIND BODY WELLNESS PC

Practice address

17304 Preston Rd Ste 800
Dallas, TX 75252-5645

Phone

(972) 849-8987

NPI assigned

Jun 10, 2006

Last updated

Feb 22, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kristi Roper, PH.D.NPI 1508807207

Title

Partner

Phone

(214) 763-1985

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Tax ID family

Mind Body Wellness PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Mind Body Wellness PC

  • Psychologist
  • Dallas, TX
  • NPI 1326208703
  NPD tax ID

Locations

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kristi Roper, PH.D.

  • Psychologist
  • Dallas, TX
  • NPI 1508807207
  Medicare reassignment Care Compare group NPD Authorized official
• Patrick Andrew Clifford, PH.D.

  • Psychologist
  • Dallas, TX
  • NPI 1467495416
  Medicare reassignment Care Compare group NPD
• Julie Dimock, LCSW

  • Clinical Social Worker
  • Dallas, TX
  • NPI 1225427974
  Medicare reassignment Care Compare group NPD
• Holly Anne Lawrence, PSYD

  • Clinical Psychologist
  • McKinney, TX
  • NPI 1760436638
  Medicare reassignment Care Compare group NPD
• Jamile Abraham Ashmore, PH.D.

  • Clinical Psychologist
  • Dallas, TX
  • NPI 1740297506
  Medicare reassignment NPD
• Tricia Favre, PH.D.

  • Clinical Psychologist
  • Plano, TX
  • NPI 1073789459
  Medicare reassignment NPD
• Dayle Cathleen Lattie, PSY.D.

  • Clinical Psychologist
  • Mandeville, LA
  • NPI 1508035353

  TX

  Medicare reassignment NPD
• Danesa Daniel, LCSW

  • Clinical Social Worker
  • Plano, TX
  • NPI 1013953710
  NPD (past)
• Laila N Hirjee, M.D.

  • Internal Medicine Physician
  • Dallas, TX
  • NPI 1588678437
  NPD (past)
• Diva Patel, CCC-SLP

  • Speech-Language Pathologist
  • Dallas, TX
  • NPI 1659097491
  NPD (past)
• Lezli L Ragland, LCSW

  • Clinical Social Worker
  • Dallas, TX
  • NPI 1184867715
  NPD (past)
• Jerianne Ranieri, LCSW

  • Clinical Social Worker
  • Dallas, TX
  • NPI 1538357405
  NPD (past)

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613952000000",
    "number": "1710929450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 934068",
            "city": "MARGATE",
            "state": "FL",
            "postal_code": "330934068",
            "telephone_number": "954-366-2700",
            "fax_number": "954-366-2056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17304 PRESTON RD STE 800",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752525645",
            "telephone_number": "972-849-8987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND BODY WELLNESS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-10",
        "last_updated": "2021-02-22",
        "certification_date": "2021-02-04",
        "status": "A",
        "authorized_official_last_name": "ROPER",
        "authorized_official_first_name": "KRISTI",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "214-763-1985",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "178166801",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Berge Minassian
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• Mind Body Wellness PC
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• Mind Haven Psychiatry PLLC
• Mind Moving Therapy
• Mind on Mend, PLLC
• Mind-Body Health Coaching of North Texas (Medi-Weightloss)

• Psychologist in Dallas, TX
• Providers in Dallas, TX by specialty
• Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2021; 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.