Provider Demographics
NPI:1336560747
Name:MIND MATTERS CLINIC
Entity Type:Organization
Organization Name:MIND MATTERS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:CANEPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-728-2184
Mailing Address - Street 1:150 BIG TREES RD, SUITE D
Mailing Address - Street 2:
Mailing Address - City:MURPHYS
Mailing Address - State:CA
Mailing Address - Zip Code:95247
Mailing Address - Country:US
Mailing Address - Phone:209-728-2184
Mailing Address - Fax:209-728-2185
Practice Address - Street 1:150 BIG TREES RD, SUITE D
Practice Address - Street 2:
Practice Address - City:MURPHYS
Practice Address - State:CA
Practice Address - Zip Code:95247
Practice Address - Country:US
Practice Address - Phone:209-728-2184
Practice Address - Fax:209-728-2185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-02
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 106H00000X, 103TC0700X
CAPSY11868103T00000X
CALCSW61384103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty