Provider Demographics
NPI:1669226650
Name:MIND MATTERS PSYCHIATRIC CLINIC PLLC
Entity type:Organization
Organization Name:MIND MATTERS PSYCHIATRIC CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STORMY
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDESPINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-560-5841
Mailing Address - Street 1:1200 BROOKLYN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4815
Mailing Address - Country:US
Mailing Address - Phone:210-560-5841
Mailing Address - Fax:201-462-3853
Practice Address - Street 1:1200 BROOKLYN AVE STE 150
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4815
Practice Address - Country:US
Practice Address - Phone:210-560-5841
Practice Address - Fax:201-462-3853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty