Mindbody Wellness, LLC
Organization Active NPI Clinical Psychologist · Aurora, MO
NPI 1992971675 · NPPES record last updated May 2, 2008
Key facts
- NPI
- 1992971675
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 2008007986 (MO)
- Legal business name
- MINDBODY WELLNESS, LLC
- Practice address
- 1407 S Elliott Ave
Suite B
Aurora, MO 65605-2103 - Phone
- (417) 440-0826
- NPI assigned
- May 2, 2008
- Organization subpart
- No
Authorized official
- Name
- Dr. Stacey L. Willis-Center, PH.D.
- Title
- Clinical Psychologist
- Phone
- (417) 440-0826
Practitioners 1
-
Stacey L. Maples, PHD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081029000103 | MO | Part B Supplier - Clinic/Group Practice | 4587722913 |
Receives reassigned benefits from 1 practitioner Practice locations: Aurora, MO |
National Provider Directory
Locations
1407 S Elliott Ave
#B
Aurora, MO 65605
Phone (417) 440-0826
1407 S Elliott Ave
Aurora, MO 65605
Phone (417) 440-0826
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist |
103TC0700X | 2008007986 | MO | Yes |
Addresses
Primary practice location
1407 S Elliott Ave
Suite B
Aurora, MO 65605-2103
Mailing address
1407 S Elliott Ave
Suite B
Aurora, MO 65605-2103
Phone (417) 440-0826
Other providers in Aurora, MO
- Mercy Hospital Springfield
- Mercy Hospital Springfield
- Darrell Eugene Meredith
- Keith A. Meyer
- Loyce Elaine Miller
- Thomas Morrison
- James Donald Myhre
- NBH3 Sfopco LLC
- Hannah Ndiba
- Jideofor Kenechi Ndulue
All providers in Aurora, MO · Clinical Psychologist in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 2, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.