MEDICARE: MIND MATTERS THERAPEUTIC SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1629901996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIND MATTERS THERAPEUTIC SERVICES

Provider Business Mailing Address
First Line	:	4926 FARGO ST
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32404-5209
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4926 FARGO STREET
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32404
Country	:	US
Telephone Number	:	850-851-8651
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AMANDA CRABTREE
Credential	:	LMHC
Telephone Number	:	850-358-0429

Provider Enumeration Date	:	06/05/2026
Last Update Date	:	06/05/2026

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