Provider Demographics
NPI:1609286558
Name:MIND ABOVE MATTER, LLC
Entity type:Organization
Organization Name:MIND ABOVE MATTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:YOSSI
Authorized Official - Middle Name:
Authorized Official - Last Name:TRESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-927-7080
Mailing Address - Street 1:PO BOX 1895
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76097-1895
Mailing Address - Country:US
Mailing Address - Phone:817-447-3001
Mailing Address - Fax:
Practice Address - Street 1:4232 HERITAGE TRACE PKWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5375
Practice Address - Country:US
Practice Address - Phone:817-447-3001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIND ABOVE MATTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-30
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty