NPIMap

Organization Active NPI

I Am Mind & Body Wellness Center, PLLC

  • Psychologist
  • San Antonio, TX
National Provider Identifier
1841790722
Registry record updated Aug 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
25013 Issued in TX
Legal business name
I AM MIND & BODY WELLNESS CENTER, PLLC
Practice address
901 NE Loop 410 Ste 508
San Antonio, TX 78209-1306
Phone
(210) 253-9763
Fax
(210) 255-1681
NPI assigned
Feb 16, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2018

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

Authorized official

Name
Dr. Susan C. Mengden, PH.D.NPI 1386738094
Title
Owner
Phone
(210) 827-5055

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X 25013 TX Primary

Addresses

Primary practice location

901 NE Loop 410 Ste 508
San Antonio, TX 78209-1306

Mailing address

901 NE Loop 410 Ste 508
San Antonio, TX 78209-1306
Phone (210) 253-9763

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1518739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533081600000",
    "number": "1841790722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 NE LOOP 410 STE 508",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782091306",
            "telephone_number": "210-253-9763",
            "fax_number": "210-255-1681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 NE LOOP 410 STE 508",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782091306",
            "telephone_number": "210-253-9763",
            "fax_number": "210-255-1681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "I AM MIND & BODY WELLNESS CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-16",
        "last_updated": "2018-08-01",
        "status": "A",
        "authorized_official_last_name": "MENGDEN",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "210-827-5055",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "TX",
            "license": "25013",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2018; 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.