Provider Demographics
NPI:1801314489
Name:MIND ABOVE MATTER LLC
Entity type:Organization
Organization Name:MIND ABOVE MATTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KINCAID
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:817-447-3001
Mailing Address - Street 1:PO BOX 1058
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76097-1058
Mailing Address - Country:US
Mailing Address - Phone:817-447-3001
Mailing Address - Fax:817-289-5623
Practice Address - Street 1:8900 CHAPIN RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-6606
Practice Address - Country:US
Practice Address - Phone:817-447-3001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-05
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)