NPIMap

Organization Active NPI

Minds Matter Behavioral Health Services

  • Clinical Social Worker
  • Stockton, CA
National Provider Identifier
1659095214
Registry record updated Sep 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
MINDS MATTER BEHAVIORAL HEALTH SERVICES
Practice address
3645 Shadowbrook Drive
Stockton, CA 95219
Phone
(209) 518-9789
NPI assigned
Sep 28, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2022

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

Authorized official

Name
Phyllis Farmer, LCSWNPI 1639899818
Title
Owner
Phone
(209) 518-9789

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

3645 Shadowbrook Drive
Stockton, CA 95219

Mailing address

2760 W Peoria Ave # 1229
Phoenix, AZ 85029-5202
Phone (209) 518-9789

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1664323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664323200000",
    "number": "1659095214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2760 W PEORIA AVE # 1229",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850295202",
            "telephone_number": "209-518-9789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3645 SHADOWBROOK DRIVE",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "95219",
            "telephone_number": "209-518-9789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDS MATTER BEHAVIORAL HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-28",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A",
        "authorized_official_last_name": "FARMER",
        "authorized_official_first_name": "PHYLLIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "209-518-9789",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2022; 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.