| Mind Over Matter Llc | |
|
131 E Covington Ave Opp AL 36467-2122 | |
| (334) 456-0300 | |
| (716) 265-3348 |
| Full Name | Mind Over Matter Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 131 E Covington Ave, Opp, Alabama |
| Authorized Official Name and Position | David Russell Adams (CRNP/ OWNER) |
| Authorized Official Contact | 3344560300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mind Over Matter Llc 29289 Beulah Church Rd Opp AL 36467-4307 Ph: (334) 456-0300 | Mind Over Matter Llc 131 E Covington Ave Opp AL 36467-2122 Ph: (334) 456-0300 |
| NPI Number | 1700402955 |
|---|---|
| Provider Enumeration Date | 06/23/2020 |
| Last Update Date | 08/23/2021 |
| Certification Date | 08/23/2021 |
| Medicare PECOS PAC ID | 5193135481 |
|---|---|
| Medicare Enrollment ID | O20201027001814 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700402955 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Beverly A Taylor |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679715452 PECOS PAC ID: 1557264116 Enrollment ID: I20040130000252 |
| Provider Name | Jonathan C Pfeifer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1235330374 PECOS PAC ID: 7214053388 Enrollment ID: I20140513001427 |
| Provider Name | David Russell Adams |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275158578 PECOS PAC ID: 7810307105 Enrollment ID: I20201028000987 |
| Provider Name | Erica Shere' Ellis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053885012 PECOS PAC ID: 6002207628 Enrollment ID: I20211215001219 |
Mind Over Matter Behavioral Health Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 131 E Covington Ave, Opp, AL 36467 Phone: 334-804-6937 Fax: 716-265-3348 | |
Innovative Behavioral Solutions Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 18549 County Road 77, Opp, AL 36467 Phone: 334-488-9889 |