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General NPI Number Information
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NPI Number | 1417437542
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Entity Type | Organization
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Legal Business Name | MIND OVER MATTER MENTAL HEALTH, LLC
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Dates
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Enumeration Date | 08/17/2018
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 1717 W FRANCIS AVE STE 204
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City | SPOKANE
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State | WA
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Zip | 99205-6858
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Country | US
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Telephone | 509-934-1925
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Fax | 509-868-0874
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Provider Business Mailing Address
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Address Line | 1717 W FRANCIS AVE STE 204
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City | SPOKANE
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State | WA
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Zip | 99205-6858
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Country | US
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Telephone | 509-934-1925
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Fax | 509-868-0874
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Authorized Official
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Title or Position | OWNER
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Name | LORRAINE JEANETTE DIRICCO
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Credential | ARNP, RN
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Telephone | 509-934-1925
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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