Active NPI
Cervello-Wellness, LLC
- Psychiatric/Mental Health Nurse Practitioner
- North Bethesda, MD
National Provider Identifier
1083239255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- Legal business name
- CERVELLO-WELLNESS, LLC
- Practice address
- 6010 Executive Blvd Ste 700
North Bethesda, MD 20852-3885 - Phone
- (301) 392-7120
- NPI assigned
- Jun 12, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mimi Tyson
- Title
- Psychiatric Nurse Practitioner
- Phone
- (301) 392-7120
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | Primary |
Addresses
Primary practice location
6010 Executive Blvd Ste 700
North Bethesda, MD 20852-3885
Mailing address
4014 Diamondhead Ave
Bowie, MD 20721-1308
Phone (301) 828-5239
Other practice location 1
403 N Henry St
Alexandria, VA 22314-2230
Phone (301) 392-7120
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 521090900 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
Enrollment records 1
National Provider Directory
National Provider DirectoryLocations
6010 Executive Blvd
Ste 700
Rockville, MD 20852
Phone (301) 392-7120
403 N Henry St
Alexandria, VA 22314
Phone (301) 392-7120
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1591920000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1780099200000",
"number": "1083239255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4014 DIAMONDHEAD AVE",
"city": "BOWIE",
"state": "MD",
"postal_code": "207211308",
"telephone_number": "301-828-5239"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6010 EXECUTIVE BLVD STE 700",
"city": "NORTH BETHESDA",
"state": "MD",
"postal_code": "208523885",
"telephone_number": "301-392-7120"
}
],
"practiceLocations": [
{
"address_1": "403 N Henry St",
"address_purpose": "LOCATION",
"city": "Alexandria",
"state": "VA",
"postal_code": "223142230",
"country_code": "US",
"telephone_number": "301-392-7120",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "CERVELLO-WELLNESS, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2020-06-12",
"last_updated": "2026-05-30",
"certification_date": "2026-05-30",
"status": "A",
"authorized_official_last_name": "TYSON",
"authorized_official_first_name": "MIMI",
"authorized_official_title_or_position": "PSYCHIATRIC NURSE PRACTITIONER",
"authorized_official_telephone_number": "301-392-7120"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "521090900",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in North Bethesda, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.