Provider Demographics
NPI:1265169858
Name:MIND'N MATTER THERAPY SERVICES P.C.
Entity type:Organization
Organization Name:MIND'N MATTER THERAPY SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DEBLANC
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:832-428-9867
Mailing Address - Street 1:8518 VISTADALE DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-2774
Mailing Address - Country:US
Mailing Address - Phone:832-428-9867
Mailing Address - Fax:
Practice Address - Street 1:8518 VISTADALE DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-2774
Practice Address - Country:US
Practice Address - Phone:832-428-9867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty