MEDICARE: MINDMATTERS HYPNOSIS AND COUNSELING, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C001378	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275816258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDMATTERS HYPNOSIS AND COUNSELING, INC.

Provider Business Mailing Address
First Line	:	1513 CRIPPLE CREEK RD
Second Line	:
City	:	KANNAPOLIS
State	:	NC
Zip	:	28081-5760
Country	:	US
Telephone Number	:	704-932-5788
Fax Number	:

Provider Business Practice Location Address
First Line	:	10225 HICKORYWOOD HILL AVE
Second Line	:	SUITE B
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-3430
Country	:	US
Telephone Number	:	704-796-8542
Fax Number	:	704-932-0538

Authorized Official
Title or Position	:	OWNER/CLINICIAN
Name	:	MS. CAROLE MILLER BOMBARDIER
Credential	:	LCSW
Telephone Number	:	704-932-5788

Provider Enumeration Date	:	09/26/2011
Last Update Date	:	09/26/2011

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