Provider Demographics
NPI:1700402955
Name:MIND OVER MATTER LLC
Entity Type:Organization
Organization Name:MIND OVER MATTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNP/ OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:334-456-0300
Mailing Address - Street 1:29289 BEULAH CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:OPP
Mailing Address - State:AL
Mailing Address - Zip Code:36467-4307
Mailing Address - Country:US
Mailing Address - Phone:334-456-0300
Mailing Address - Fax:
Practice Address - Street 1:131 E COVINGTON AVE
Practice Address - Street 2:
Practice Address - City:OPP
Practice Address - State:AL
Practice Address - Zip Code:36467-2122
Practice Address - Country:US
Practice Address - Phone:334-456-0300
Practice Address - Fax:716-265-3348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)