Mind, Body and Soul, LLC

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

001163 Issued in CT

Legal business name

MIND, BODY AND SOUL, LLC

Practice address

21 New Britain Ave
Suite 215
Rocky Hill, CT 06067-1100

Phone

(860) 716-6246

NPI assigned

Nov 30, 2010

Organization subpart

No

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

Authorized official

Name

Melissa Kelly, LMFT

Title

Owner

Phone

(860) 716-6246

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1291075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291075200000",
    "number": "1891097630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 NEW BRITAIN AVE",
            "address_2": "SUITE 215",
            "city": "ROCKY HILL",
            "state": "CT",
            "postal_code": "060671100",
            "telephone_number": "860-716-6246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 NEW BRITAIN AVE",
            "address_2": "SUITE 215",
            "city": "ROCKY HILL",
            "state": "CT",
            "postal_code": "060671100",
            "telephone_number": "860-716-6246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND, BODY AND SOUL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-30",
        "last_updated": "2010-11-30",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-716-6246",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "CT",
            "license": "001163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in Rocky Hill, CT
• Providers in Rocky Hill, CT by specialty
• Marriage & Family Therapist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2010; 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.