Healthcare Provider Details

I. General information

NPI: 1508586041
Provider Name (Legal Business Name): MIND OVER MATTER COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 BRIDGE RD # C2
SALISBURY MA
01952-2404
US

IV. Provider business mailing address

3 BRIDGE RD # C2
SALISBURY MA
01952-2404
US

V. Phone/Fax

Practice location:
  • Phone: 603-475-9638
  • Fax:
Mailing address:
  • Phone: 603-475-9638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EMILY JACOBS
Title or Position: CEO/THERAPIST
Credential: LMHC
Phone: 603-475-9638