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General NPI Number Information
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NPI Number | 1609286558
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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 | 04/30/2014
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Last Update Date | 11/03/2023
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Provider Practice Location Address
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Address Line | 4232 HERITAGE TRACE PKWY
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City | FORT WORTH
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State | TX
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Zip | 76244-5375
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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 1895
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City | BURLESON
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State | TX
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Zip | 76097-1895
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Country | US
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Telephone | 817-447-3001
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | YOSSI TRESS
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Credential |
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Telephone | 732-927-7080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #4
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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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