Creative Minds Behavioral Health, LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

CREATIVE MINDS BEHAVIORAL HEALTH, LLC

Practice address

110 W Randol Mill Rd Ste 200
Arlington, TX 76011-4612

Phone

(214) 892-7151

Fax

(214) 602-9919

NPI assigned

May 11, 2020

Last updated

Aug 30, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tralica Clewis

Title

Credential/Billing

Phone

(469) 586-7643

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1589155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598745600000",
    "number": "1588286793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 W RANDOL MILL RD STE 200",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760114612",
            "telephone_number": "214-892-7151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 W RANDOL MILL RD STE 200",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760114612",
            "telephone_number": "214-892-7151",
            "fax_number": "214-602-9919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREATIVE MINDS BEHAVIORAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-11",
        "last_updated": "2020-08-30",
        "certification_date": "2020-08-30",
        "status": "A",
        "authorized_official_last_name": "CLEWIS",
        "authorized_official_first_name": "TRALICA",
        "authorized_official_title_or_position": "CREDENTIAL/BILLING",
        "authorized_official_telephone_number": "469-586-7643"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "389918903",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "EHR",
            "affiliation": "N",
            "address_1": "110 W Randol Mill Rd Ste 200",
            "city": "Arlington",
            "state": "TX",
            "country_code": "US",
            "postal_code": "760114612",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Arlington, TX
• Providers in Arlington, TX by specialty
• Psychiatric/Mental Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.