Provider Demographics
NPI: | 1467176313 |
---|---|
Name: | MIND MATTERS LLC |
Entity Type: | Organization |
Organization Name: | MIND MATTERS LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MANAGING MEMBER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | COLLEEN |
Authorized Official - Middle Name: | SANDERS |
Authorized Official - Last Name: | ALFORD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PMHNP |
Authorized Official - Phone: | 808-888-5683 |
Mailing Address - Street 1: | 735 BISHOP ST STE 414 |
Mailing Address - Street 2: | |
Mailing Address - City: | HONOLULU |
Mailing Address - State: | HI |
Mailing Address - Zip Code: | 96813-4824 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 808-888-5683 |
Mailing Address - Fax: | 808-888-5683 |
Practice Address - Street 1: | 735 BISHOP ST STE 414 |
Practice Address - Street 2: | |
Practice Address - City: | HONOLULU |
Practice Address - State: | HI |
Practice Address - Zip Code: | 96813-4824 |
Practice Address - Country: | US |
Practice Address - Phone: | 808-888-5683 |
Practice Address - Fax: | 808-888-5683 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2022-10-03 |
Last Update Date: | 2022-10-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Single Specialty |