| Organization Name: | MIND-BODY MANAGEMENT, LTD. |
| NPI Number: | 1396987046 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KELLI J DEIACO (PRESIDENT) |
| Mailing Address: | 108 S Church St Macungie |
| State: | PA US |
| Postal Code: | 180621038 |
| Phone Number: | 6104625585 |
| Fax Number: | 6109665616 |
| NPI Enumeration Date: | 03/26/2009 |
| NPI Last Update Date: | 06/15/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM0850X |
| License Number: | PC004790 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Adult Mental Health |
| Taxonomy Definition: | An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. |