Healthcare Provider Details

I. General information

NPI: 1629901996
Provider Name (Legal Business Name): MIND MATTERS THERAPEUTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4926 FARGO STREET
PANAMA CITY FL
32404
US

IV. Provider business mailing address

4926 FARGO ST
PANAMA CITY FL
32404-5209
US

V. Phone/Fax

Practice location:
  • Phone: 850-851-8651
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: AMANDA CRABTREE
Title or Position: OWNER
Credential: LMHC
Phone: 850-358-0429