# MIND GYM NEUROFEEDBACK, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588471239
- **Authorized official:** MR. LEROY MATTICKS (CEO)
- **Authorized official phone:** (720) 290-0154

## Contact information

- **Practice address:** 5322 PRIMROSE LAKE CIR STE H, TAMPA, FL 33647-3659
- **Practice address phone:** (720) 233-2299
- **Mailing address:** 5322 PRIMROSE LAKE CIR STE H, TAMPA, FL 33647-3659
- **Mailing address phone:** (720) 233-2299

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |

## Other

- **Enumeration date:** 12/16/2024
- **Last updated:** 12/16/2024