| Mind Body Endurance Llc | |
|
16 N Gore Ave Ste 204 Saint Louis MO 63119-2315 | |
| (513) 505-2160 | |
| Not Available |
| Full Name | Mind Body Endurance Llc |
|---|---|
| Speciality | Psychologist - Exercise & Sports |
| Location | 16 N Gore Ave Ste 204, Saint Louis, Missouri |
| Authorized Official Name and Position | Riley Nickols (OWNER) |
| Authorized Official Contact | 5135052160 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mind Body Endurance Llc 16 N Gore Ave Ste 204 Saint Louis MO 63119-2315 Ph: (513) 505-2160 | Mind Body Endurance Llc 16 N Gore Ave Ste 204 Saint Louis MO 63119-2315 Ph: (513) 505-2160 |
| NPI Number | 1053018903 |
|---|---|
| Provider Enumeration Date | 02/10/2023 |
| Last Update Date | 02/10/2023 |
| Certification Date | 02/10/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053018903 | NPI | - | NPPES |
| 1790019511 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TE1100X | Psychologist - Exercise & Sports | (* (Not Available)) | Primary |
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