NPIMap

Organization Active NPI

Minds Matter

  • Clinical Social Worker
  • Clarksville, TN
National Provider Identifier
1730740309
Registry record updated May 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
MINDS MATTER
Practice address
118 Medical CT
Clarksville, TN 37043-4602
Phone
(931) 408-9909
NPI assigned
Jun 25, 2019
Last updated
May 3, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 3, 2023

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

Authorized official

Name
Terrance Page, BS INFORMATION SYS
Title
Member
Phone
(931) 561-5252

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary
Adolescent and Children Mental Health Clinic/Center 261QM0855X

Addresses

Primary practice location

118 Medical CT
Clarksville, TN 37043-4602

Mailing address

118 Medical CT
Clarksville, TN 37043-4602
Phone (931) 408-9909

Other practice location 1

123 W 7th St
Hopkinsville, KY 42240-2101
Phone (931) 408-9909

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL www.mindsmattertn.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211102002297 TN Part B Supplier - Clinic/Group Practice 6002204559 Receives reassigned benefits from 1 practitioner
Practice locations: Clarksville, TN

National Provider Directory

National Provider Directory
Tax ID family
Minds Matter2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

118 Medical Ct
Clarksville, TN 37043
Phone (931) 408-9909

Practitioners & affiliated clinicians

Practitioners 10

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": "1561420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683072000000",
    "number": "1730740309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 MEDICAL CT",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370434602",
            "telephone_number": "931-408-9909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 MEDICAL CT",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370434602",
            "telephone_number": "931-408-9909"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "123 W 7th St",
            "address_purpose": "LOCATION",
            "city": "Hopkinsville",
            "state": "KY",
            "postal_code": "422402101",
            "country_code": "US",
            "telephone_number": "931-408-9909",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MINDS MATTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-25",
        "last_updated": "2023-05-03",
        "certification_date": "2023-05-03",
        "status": "A",
        "authorized_official_last_name": "PAGE",
        "authorized_official_first_name": "TERRANCE",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "931-561-5252",
        "authorized_official_credential": "BS INFORMATION SYS"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.mindsmattertn.org",
            "affiliation": "N",
            "address_1": "1989 Madison St",
            "city": "Clarksville",
            "state": "TN",
            "country_code": "US",
            "postal_code": "370435067",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Clarksville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2023; 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.