MEDICARE: MATTERS OF THE MIND, 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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

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	:	1477187953
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATTERS OF THE MIND, LLC

Provider Business Mailing Address
First Line	:	4538 W CRAIG RD STE 240
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-2510
Country	:	US
Telephone Number	:	702-647-6433
Fax Number	:	702-647-6434

Provider Business Practice Location Address
First Line	:	4538 W CRAIG RD STE 240
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-2510
Country	:	US
Telephone Number	:	702-647-6433
Fax Number	:	702-647-6434

Authorized Official
Title or Position	:	CEO
Name	:	ANTRANIQUE LOWE
Credential	:
Telephone Number	:	702-647-6433

Provider Enumeration Date	:	02/24/2020
Last Update Date	:	02/24/2020

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Directions to “MATTERS OF THE MIND, LLC ” Practice Location

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