Provider Demographics
NPI:1669625752
Name:MINDMATTERS LLC
Entity Type:Organization
Organization Name:MINDMATTERS LLC
Other - Org Name:JOHN ROBERT MILANOVICH
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MILANOVICH
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:734-222-0201
Mailing Address - Street 1:3007 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-2122
Mailing Address - Country:US
Mailing Address - Phone:734-222-0201
Mailing Address - Fax:734-222-0234
Practice Address - Street 1:3007 MILLER RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-2122
Practice Address - Country:US
Practice Address - Phone:734-222-0201
Practice Address - Fax:734-222-0234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010984103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty