Provider Demographics
NPI:1477314524
Name:MIND MATTERS COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:MIND MATTERS COUNSELING SERVICES, LLC
Other - Org Name:MIND MATTERS COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHANNING
Authorized Official - Middle Name:J
Authorized Official - Last Name:STARKS
Authorized Official - Suffix:
Authorized Official - Credentials:ALC
Authorized Official - Phone:334-432-6035
Mailing Address - Street 1:830 N OUIDA ST
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-2704
Mailing Address - Country:US
Mailing Address - Phone:334-432-6035
Mailing Address - Fax:
Practice Address - Street 1:621 BOLL WEEVIL CIR STE 33
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2749
Practice Address - Country:US
Practice Address - Phone:334-475-2422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-17
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty