# MIND ABOVE MATTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MIND ABOVE MATTER LLC
- **Other names:** iMatter OD Wyatt
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1629565189
- **Legal business name:** MIND ABOVE MATTER LLC
- **Authorized official:** MISTY MOLINA (BUSINESS OFFICE DIRECTOR)
- **Authorized official phone:** (817) 447-3001

## Contact information

- **Practice address:** 2400 E SEMINARY DR, FORT WORTH, TX 76119-5502
- **Practice address phone:** (817) 447-3001
- **Practice address fax:** (817) 289-5699
- **Mailing address:** PO BOX 1058, BURLESON, TX 76097-1058
- **Mailing address phone:** (817) 447-3001
- **Mailing address fax:** (817) 289-5623

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 04/19/2018
- **Last updated:** 04/19/2018