Healthcare Provider Details

I. General information

NPI: 1689487639
Provider Name (Legal Business Name): MINDFUL OVER MATTER PSYCHIATRY & WELLNESS DBA MINDFUL OVER MATTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1261 S CONGRESS AVE
WEST PALM BEACH FL
33406-5172
US

IV. Provider business mailing address

11017 MULBERRY GARDEN TRL
BOYNTON BEACH FL
33473-5091
US

V. Phone/Fax

Practice location:
  • Phone: 561-814-8143
  • Fax: 855-526-7606
Mailing address:
  • Phone: 561-814-8143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JESSICA KOFMAN
Title or Position: OWNER
Credential: FNP-BC, PMHNP-BC
Phone: 561-814-8143