Provider Demographics
NPI:1265271639
Name:MIND OVER MATTERS THERAPEUTIC & WELLNESS SERVICES, LLC
Entity type:Organization
Organization Name:MIND OVER MATTERS THERAPEUTIC & WELLNESS SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARONDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAGWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:774-209-2372
Mailing Address - Street 1:109 RHODE ISLAND RD STE 4B
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-1370
Mailing Address - Country:US
Mailing Address - Phone:774-209-2372
Mailing Address - Fax:774-217-7242
Practice Address - Street 1:109 RHODE ISLAND RD
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MA
Practice Address - Zip Code:02347-1370
Practice Address - Country:US
Practice Address - Phone:774-209-2372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-23
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty