Provider Demographics
NPI:1255741104
Name:MIND ABOVE MATTER, LLC
Entity type:Organization
Organization Name:MIND ABOVE MATTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KINCAID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-447-3001
Mailing Address - Street 1:PO BOX 1895
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76097-1895
Mailing Address - Country:US
Mailing Address - Phone:817-447-3001
Mailing Address - Fax:817-447-3299
Practice Address - Street 1:2915 S INTERSTATE 35 W
Practice Address - Street 2:NONE
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-1445
Practice Address - Country:US
Practice Address - Phone:817-447-3001
Practice Address - Fax:817-447-3299
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIND ABOVE MATTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)