Healthcare Provider Details

I. General information

NPI: 1376715748
Provider Name (Legal Business Name): MIND OVER MATTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2008
Last Update Date: 03/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3346 CURRY FORD RD
ORLANDO FL
32806-3487
US

IV. Provider business mailing address

3346 CURRY FORD RD
ORLANDO FL
32806-3487
US

V. Phone/Fax

Practice location:
  • Phone: 407-765-4223
  • Fax:
Mailing address:
  • Phone: 407-765-4223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number50093
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number50093
License Number StateFL

VIII. Authorized Official

Name: MR. VOLTAIRE E. NUNEZ
Title or Position: PRESIDENT
Credential: PH.D
Phone: 407-765-4223