=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821652744
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MINDS MATTER 2, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2019
-----------------------------------------------------
Last Update Date | 04/16/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 SOUTHLAND DR STE 232
-----------------------------------------------------
City | VESTAVIA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35226-3735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-260-1014
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 SOUTHLAND DR STE 232
-----------------------------------------------------
City | VESTAVIA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35226-3735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-260-1014
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. TERRA GRIFFIN
-----------------------------------------------------
Credential | ED.D.,LPC-S,NCC
-----------------------------------------------------
Telephone | 205-260-1014
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------