Provider Demographics
NPI:1679128367
Name:MIND ABOVE
Entity Type:Organization
Organization Name:MIND ABOVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:FUSCO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:469-496-5695
Mailing Address - Street 1:4849 GREENVILLE AVE STE 100-101
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-4130
Mailing Address - Country:US
Mailing Address - Phone:469-496-5695
Mailing Address - Fax:469-242-9730
Practice Address - Street 1:4849 GREENVILLE AVE STE 100-101
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-4130
Practice Address - Country:US
Practice Address - Phone:469-496-5695
Practice Address - Fax:469-242-9730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty