Provider Demographics
NPI:1114656436
Name:MIND MATTERS COLLECTIVE, LLC
Entity Type:Organization
Organization Name:MIND MATTERS COLLECTIVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMAYO
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:763-249-5031
Mailing Address - Street 1:1107 HAZELTINE BLVD STE 470M-D59
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-1009
Mailing Address - Country:US
Mailing Address - Phone:763-249-5031
Mailing Address - Fax:
Practice Address - Street 1:1107 HAZELTINE BLVD STE 470M-D59
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1009
Practice Address - Country:US
Practice Address - Phone:763-249-5031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)