Provider Demographics
NPI:1326860925
Name:MIND OVER MATTER HEALTHCARE INC.
Entity type:Organization
Organization Name:MIND OVER MATTER HEALTHCARE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ARNP
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:360-423-6181
Mailing Address - Street 1:677 WOODLAND SQUARE LOOP SE # C2
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1000
Mailing Address - Country:US
Mailing Address - Phone:360-623-4181
Mailing Address - Fax:360-282-1044
Practice Address - Street 1:166 TRI MOUNTAIN LN
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-8987
Practice Address - Country:US
Practice Address - Phone:360-520-0780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-26
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty