Provider Demographics
NPI:1518749845
Name:MIND OVER MATTER MARRIAGE AND FAMILY THERAPY , PLLC
Entity Type:Organization
Organization Name:MIND OVER MATTER MARRIAGE AND FAMILY THERAPY , PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JINAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-554-5710
Mailing Address - Street 1:42 SYOSSET CIR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4808
Mailing Address - Country:US
Mailing Address - Phone:516-201-8191
Mailing Address - Fax:
Practice Address - Street 1:42 SYOSSET CIR
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4808
Practice Address - Country:US
Practice Address - Phone:516-201-8191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-20
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health