Provider Demographics
NPI:1053092080
Name:MIND OVER MATTER
Entity type:Organization
Organization Name:MIND OVER MATTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUBSTANCE ABUSE COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DOSS
Authorized Official - Suffix:
Authorized Official - Credentials:CSAC
Authorized Official - Phone:608-886-4716
Mailing Address - Street 1:1703 CITY VIEW DR APT 121
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53718-2410
Mailing Address - Country:US
Mailing Address - Phone:608-886-4716
Mailing Address - Fax:
Practice Address - Street 1:1703 CITY VIEW DR APT 121
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-2410
Practice Address - Country:US
Practice Address - Phone:608-886-4716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty