Provider Demographics
NPI:1861030769
Name:MIND OVER MATTERS PRACTICE MANAGEMENT INC
Entity Type:Organization
Organization Name:MIND OVER MATTERS PRACTICE MANAGEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:714-654-1570
Mailing Address - Street 1:17111 BEACH BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-5947
Mailing Address - Country:US
Mailing Address - Phone:714-654-1570
Mailing Address - Fax:844-533-6952
Practice Address - Street 1:17111 BEACH BLVD STE 205
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-5947
Practice Address - Country:US
Practice Address - Phone:714-654-1570
Practice Address - Fax:844-533-6952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty