Mind Gym Neurofeedback, LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

MIND GYM NEUROFEEDBACK, LLC

Practice address

730 S Sterling Ave Ste 301
Tampa, FL 33609-4524

Phone

(720) 305-6583

Fax

(720) 222-5533

NPI assigned

Dec 16, 2024

Organization subpart

Yes

Parent organization

MIND GYM NEUROFEEDBACK, LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Leroy Matticks

Title

Ceo

Phone

(720) 290-0154

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Mind Gym Neurofeedback, LLC

  • Mental Health Counselor
  • Tampa, FL
  • NPI 1588471239

  O20250818003687

  Same enrollment

Tax ID family

Mind Gym Neurofeedback LLC2 organizations share this tax ID, including this one

Part of

Mind Gym Neurofeedback LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Mind Gym Neurofeedback, LLC

  • Mental Health Counselor
  • Tampa, FL
  • NPI 1588471239
  NPD tax ID

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Mind Gym Neurofeedback, LLC

  • Mental Health Counselor
  • Tampa, FL
  • NPI 1588471239
  NPPES parent name

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stephanie Moir, LMHC

  • Mental Health Counselor
  • Tampa, FL
  • NPI 1639430507
  NPD
• Giovanna Treglio, LPC, LMHC

  • Mental Health Counselor
  • Spokane, WA
  • NPI 1518584911
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1734307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734307200000",
    "number": "1023825775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5322 PRIMROSE LAKE CIR STE H",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336473659",
            "telephone_number": "720-305-6583",
            "fax_number": "720-222-5533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 S STERLING AVE STE 301",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336094524",
            "telephone_number": "720-305-6583",
            "fax_number": "720-222-5533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND GYM NEUROFEEDBACK, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MIND GYM NEUROFEEDBACK, LLC",
        "enumeration_date": "2024-12-16",
        "last_updated": "2024-12-16",
        "certification_date": "2024-12-16",
        "status": "A",
        "authorized_official_last_name": "MATTICKS",
        "authorized_official_first_name": "LEROY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "720-290-0154",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dominick Minaya
• Sarah Minaya, MS, RDN
• Miranda Minchillo
• Karla Michelle Mincone, PA-C
• Mind and Body Interventions
• Mind Gym Neurofeedback, LLC
• Mindbodyspirit Care Inc
• Mindbrook Psychiatry LLC
• Mindful ABA Interventions LLC
• Mindful ABA Services LLC

• Mental Health Counselor in Tampa, FL
• Providers in Tampa, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.