Healthcare Provider Details

I. General information

NPI: 1639954076
Provider Name (Legal Business Name): YOUR MOOD MATTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3328 MORRELL AVE
PHILADELPHIA PA
19114-1222
US

IV. Provider business mailing address

1950 BUTLER PIKE UNIT 170
CONSHOHOCKEN PA
19428-1202
US

V. Phone/Fax

Practice location:
  • Phone: 484-381-0158
  • Fax: 445-999-5251
Mailing address:
  • Phone: 484-381-0158
  • Fax: 445-999-5251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. AMBER R NELSON
Title or Position: ADMIN
Credential: NP
Phone: 215-768-5885