NPIMap

Organization Active NPI

Mind Above Matter LLC

  • Adolescent and Children Mental Health Clinic/Center
  • Fort Worth, TX
National Provider Identifier
1629565189
Registry record updated Apr 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
MIND ABOVE MATTER LLC
Practice address
2400 E Seminary Dr
Fort Worth, TX 76119-5502
Phone
(817) 447-3001
Fax
(817) 289-5699
NPI assigned
Apr 19, 2018
Organization subpart
Yes
Parent organization
MIND ABOVE MATTER LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 19, 2018

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

Authorized official

Name
Misty Molina
Title
Business Office Director
Phone
(817) 447-3001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X Primary

Addresses

Primary practice location

2400 E Seminary Dr
Fort Worth, TX 76119-5502

Mailing address

PO Box 1058
Burleson, TX 76097-1058
Phone (817) 447-3001

Other names 1

  • iMatter OD Wyatt Other name

National Provider Directory

National Provider Directory
Tax ID family
Ips Irving22 organizations share this tax ID, including this one
Part of
Ips Irving

Other organizations with this tax ID 21

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

View all 21

Locations

2400 E Seminary Dr
Fort Worth, TX 76119

NPI Registry JSON

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

{
    "created_epoch": "1524096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524096000000",
    "number": "1629565189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1058",
            "city": "BURLESON",
            "state": "TX",
            "postal_code": "760971058",
            "telephone_number": "817-447-3001",
            "fax_number": "817-289-5623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 E SEMINARY DR",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761195502",
            "telephone_number": "817-447-3001",
            "fax_number": "817-289-5699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND ABOVE MATTER LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MIND ABOVE MATTER LLC",
        "enumeration_date": "2018-04-19",
        "last_updated": "2018-04-19",
        "status": "A",
        "authorized_official_last_name": "MOLINA",
        "authorized_official_first_name": "MISTY",
        "authorized_official_title_or_position": "BUSINESS OFFICE DIRECTOR",
        "authorized_official_telephone_number": "817-447-3001"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "iMatter OD Wyatt",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.