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General NPI Number Information
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NPI Number | 1326860925
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Entity Type | Organization
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Legal Business Name | MIND OVER MATTER HEALTHCARE INC.
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Dates
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Enumeration Date | 10/26/2024
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 166 TRI MOUNTAIN LN
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City | CENTRALIA
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State | WA
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Zip | 98531-8987
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Country | US
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Telephone | 360-520-0780
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Fax |
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Provider Business Mailing Address
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Address Line | 677 WOODLAND SQUARE LOOP SE # C2
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City | LACEY
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State | WA
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Zip | 98503-1000
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Country | US
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Telephone | 360-623-4181
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Fax | 360-282-1044
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Authorized Official
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Title or Position | ARNP
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Name | DR. JASON RUSSELL JOHNSON
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Credential | DNP
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Telephone | 360-423-6181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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