Provider Demographics
NPI:1760209837
Name:MYNDZMATTER.COM
Entity type:Organization
Organization Name:MYNDZMATTER.COM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/ PEER SUPPORT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:TONY
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-820-5140
Mailing Address - Street 1:524 MAIN ST STE 207
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-3455
Mailing Address - Country:US
Mailing Address - Phone:916-820-5140
Mailing Address - Fax:
Practice Address - Street 1:524 MAIN ST STE 207
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3455
Practice Address - Country:US
Practice Address - Phone:916-820-5140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)