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General NPI Number Information
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NPI Number | 1578144465
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Entity Type | Organization
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Legal Business Name | MIND ABOVE MATTER, LLC
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Dates
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Enumeration Date | 04/21/2021
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Last Update Date | 04/21/2021
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Provider Practice Location Address
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Address Line | 1701 W NORTHWEST HWY STE 100
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City | GRAPEVINE
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State | TX
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Zip | 76051-8145
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Country | US
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Telephone | 817-447-3001
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1058
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City | BURLESON
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State | TX
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Zip | 76097-1058
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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 | BUSINESS OFFICE DIRECTOR
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Name | MISTY MOLINA
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Credential |
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Telephone | 817-447-3001
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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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