MEDICARE: INMINDOUT EMOTIONAL WELLNESS CENTER, LLC

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	101YP2500X	Professional Counselor
2	103T00000X	Psychologist	36336	TX

General Provider Information

NPI Number	:	1457799330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INMINDOUT EMOTIONAL WELLNESS CENTER, LLC

Provider Business Mailing Address
First Line	:	645 N WALNUT AVE
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78130-7925
Country	:	US
Telephone Number	:	830-730-6090
Fax Number	:	830-455-4355

Provider Business Practice Location Address
First Line	:	645 N WALNUT AVE
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78130-7925
Country	:	US
Telephone Number	:	830-730-6090
Fax Number	:	830-455-4355

Authorized Official
Title or Position	:	CEO
Name	:	DR. HEATHER MASTRIANNO
Credential	:	PSYD
Telephone Number	:	210-787-0200

Provider Enumeration Date	:	06/12/2013
Last Update Date	:	08/25/2025

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