| Mind Body Program Llc | |
|
15300 Watertown Plank Rd Ste 106 Elm Grove WI 53122-2348 | |
| (414) 807-8934 | |
| Not Available |
| Full Name | Mind Body Program Llc |
|---|---|
| Speciality | Psychologist |
| Location | 15300 Watertown Plank Rd Ste 106, Elm Grove, Wisconsin |
| Authorized Official Name and Position | Lauri Christine Gebhard (PSYCHOLOGIST) |
| Authorized Official Contact | 4148078934 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mind Body Program Llc 15300 Watertown Plank Rd #106 Elm Grove WI 53122-2300 Ph: (414) 807-8934 | Mind Body Program Llc 15300 Watertown Plank Rd Ste 106 Elm Grove WI 53122-2348 Ph: (414) 807-8934 |
| NPI Number | 1205084118 |
|---|---|
| Provider Enumeration Date | 09/04/2008 |
| Last Update Date | 11/01/2024 |
| Certification Date | 11/01/2024 |
| Medicare PECOS PAC ID | 4183756877 |
|---|---|
| Medicare Enrollment ID | O20100715000508 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205084118 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TH0004X | Psychologist - Health | 2028 (Wisconsin) | Primary |
| Provider Name | Lauri C Gebhard |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1538276720 PECOS PAC ID: 8022056894 Enrollment ID: I20050421000836 |
| Provider Name | Larisa Hutchins |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1841344256 PECOS PAC ID: 6608022637 Enrollment ID: I20160627002425 |
| Provider Name | Rachel M Sheffler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881283463 PECOS PAC ID: 2264849504 Enrollment ID: I20220414000806 |
| Provider Name | Lyndsy Marie Mirasola |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053719138 PECOS PAC ID: 9739419987 Enrollment ID: I20231204001905 |
| Provider Name | Julie L Educate |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1134602733 PECOS PAC ID: 2961847918 Enrollment ID: I20240229000664 |
| Provider Name | Mary Miller |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1770659815 PECOS PAC ID: 5698902666 Enrollment ID: I20240522000655 |
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