Basic Information
| Provider Information | |||||||||
| NPI: | 1093308744 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MIND OVER MATTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 344 ASTER ST | ||||||||
| Address2: | |||||||||
| City: | CASPER | ||||||||
| State: | WY | ||||||||
| PostalCode: | 826045385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3074213650 | ||||||||
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| Practice Location | |||||||||
| Address1: | 145 S DURBIN ST | ||||||||
| Address2: | |||||||||
| City: | CASPER | ||||||||
| State: | WY | ||||||||
| PostalCode: | 826012538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3074213650 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2021 | ||||||||
| LastUpdateDate: | 02/13/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BURT | ||||||||
| AuthorizedOfficialFirstName: | SARAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 3074213650 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | PMHNP-C | ||||||||
| NPICertificationDate: | 02/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.