Healthcare Provider Details

I. General information

NPI: 1184922999
Provider Name (Legal Business Name): MIND OVER MATTER RECLAMATION CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 N 45TH ST
OMAHA NE
68104-3711
US

IV. Provider business mailing address

PO BOX 24328
OMAHA NE
68124-0328
US

V. Phone/Fax

Practice location:
  • Phone: 402-359-3817
  • Fax: 206-309-9598
Mailing address:
  • Phone: 402-359-3817
  • Fax: 206-309-9598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number824
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number824
License Number StateNE

VIII. Authorized Official

Name: FARANITA DUNBAR
Title or Position: CEO
Credential: LIMHP
Phone: 402-359-3817