| Mindbody Wellness, Llc | |
|
1407 S Elliott Ave Suite B Aurora MO 65605-2103 | |
| (417) 440-0826 | |
| Not Available |
| Full Name | Mindbody Wellness, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 1407 S Elliott Ave, Aurora, Missouri |
| Authorized Official Name and Position | Stacey L. Willis-center (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 4174400826 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mindbody Wellness, Llc 1407 S Elliott Ave Suite B Aurora MO 65605-2103 Ph: (417) 440-0826 | Mindbody Wellness, Llc 1407 S Elliott Ave Suite B Aurora MO 65605-2103 Ph: (417) 440-0826 |
| NPI Number | 1992971675 |
|---|---|
| Provider Enumeration Date | 05/02/2008 |
| Last Update Date | 05/02/2008 |
| Medicare PECOS PAC ID | 4587722913 |
|---|---|
| Medicare Enrollment ID | O20081029000103 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992971675 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 2008007986 (Missouri) | Primary |
| Provider Name | Stacey L Maples |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1699947804 PECOS PAC ID: 6305740234 Enrollment ID: I20081029000093 |
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