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General NPI Number Information
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NPI Number | 1346112653
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Entity Type | Organization
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Legal Business Name | MIND OVER MATTER TRANSFORMATION CENTER LLC
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Dates
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Enumeration Date | 09/18/2025
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 7901 4TH ST N SUITE 300
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City | ST. PETERSBURG
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State | FL
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Zip | 33702
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Country | US
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Telephone | 850-669-0022
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Fax |
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Provider Business Mailing Address
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Address Line | 2821 S FERDON BLVD # 1087
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City | CRESTVIEW
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State | FL
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Zip | 32536-8474
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | CONNIKA GREEN
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Credential | LCSW
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Telephone | 850-669-0022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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