MEDICARE: MIND OVER MATTER COUNSELING SERVICES 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	261QM0850X	Adult Mental Health Clinic/Center	5045	NE

General Provider Information

NPI Number	:	1750872149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIND OVER MATTER COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	955 N ADAMS ST STE 8
Second Line	:
City	:	PAPILLION
State	:	NE
Zip	:	68046-3080
Country	:	US
Telephone Number	:	531-444-1963
Fax Number	:

Provider Business Practice Location Address
First Line	:	955 N ADAMS ST STE 8
Second Line	:
City	:	PAPILLION
State	:	NE
Zip	:	68046-3080
Country	:	US
Telephone Number	:	531-444-1963
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MYISHA PARSHA
Credential	:	LIMHP
Telephone Number	:	531-444-1963

Provider Enumeration Date	:	05/22/2018
Last Update Date	:	10/18/2024

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