Provider Demographics
NPI:1427395029
Name:MIND MATTERS, LLC
Entity Type:Organization
Organization Name:MIND MATTERS, LLC
Other - Org Name:SERENITY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:HICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, PSYD
Authorized Official - Phone:423-800-0483
Mailing Address - Street 1:3097 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37408-3093
Mailing Address - Country:US
Mailing Address - Phone:423-800-0483
Mailing Address - Fax:423-752-5299
Practice Address - Street 1:3097 BROAD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37408-3093
Practice Address - Country:US
Practice Address - Phone:423-800-0483
Practice Address - Fax:423-752-5299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3680046Medicare PIN