Provider Demographics
NPI:1386115814
Name:MIND MATTER LLC
Entity type:Organization
Organization Name:MIND MATTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-273-2507
Mailing Address - Street 1:307 S FRONT ST STE 115
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4610
Mailing Address - Country:US
Mailing Address - Phone:906-273-2507
Mailing Address - Fax:906-273-2508
Practice Address - Street 1:307 S FRONT ST STE 115
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4610
Practice Address - Country:US
Practice Address - Phone:906-273-2507
Practice Address - Fax:906-273-2507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-10
Last Update Date:2022-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty