MEDICARE: MIND MATTERS LIMITED LIABILITY COMPANY

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	:	1831047893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIND MATTERS LIMITED LIABILITY COMPANY

Provider Business Mailing Address
First Line	:	5801 CEDAR LAKE RD S STE 112
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-1481
Country	:	US
Telephone Number	:	612-662-6236
Fax Number	:

Provider Business Practice Location Address
First Line	:	5801 CEDAR LAKE RD S STE 112
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-1481
Country	:	US
Telephone Number	:	612-662-6236
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	CHRISTINA NULTY
Credential	:
Telephone Number	:	262-349-1328

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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Directions to “MIND MATTERS LIMITED LIABILITY COMPANY ” Practice Location

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