MIND BODY PROGRAM LLC NPI 1205084118

NPI Information

  • NPI: 1205084118
  • Provider Name: MIND BODY PROGRAM LLC
  • Classification: Psychologist - 103TH0004X
  • Specialization: Health
  • Entity Type: Organization
  • Doing Business As: MIND BODY PROGRAM LLC
  • Address: 15300 WATERTOWN PLANK RD STE 106
    ELM GROVE, WI
    ZIP 53122
  • Phone: (414) 807-8934

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NPI Details

MIND BODY PROGRAM LLC is a health psychologist in Elm Grove, WI. The provider is a psychologist who specializes in clinical health psychology that investigates and implements clinical services across diverse populations and settings to promote health and well-being and to prevent, treat, and manage illness and disability. Clinical health psychology sees health as the confluence of psychological, social, cultural, and biological factors and applies this understanding to professional activities including:

  • MIND BODY PROGRAM LLC NPI is 1205084118. The provider is registered as an organization entity type and is a single specialty group.
    The provider Is Doing Business As Mind Body Program Llc.

    The provider's business location address is:

    15300 WATERTOWN PLANK RD STE 106
    ELM GROVE, WI
    ZIP 53122-348
    Phone: (414) 807-8934

    The provider's authorized official is Lauri Christine Gebhard .
    The authorized official title is Psychologist and has the following contact phone number (414) 807-8934.

    The enumeration date for this NPI number is 9/4/2008 and was last updated on 11/1/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1103TH0004XPsychologistHealth2028WISCONSINYes

What is NPI?

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This page was last updated on: 3/30/2025

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