Mystic Behavioral Health Services

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

MYSTIC BEHAVIORAL HEALTH SERVICES

Practice address

2285 Renaissance Dr Ste B
Las Vegas, NV 89119-6754

Phone

(725) 200-6402

NPI assigned

Mar 31, 2022

Organization subpart

No

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

Authorized official

Name

Erica NorwoodNPI 1962055228

Title

Ceo

Phone

(725) 200-6402

Specialties & licenses 1

Addresses

Other names 1

• Mystic Behavioral Health Services Former legal business name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Erica Norwood

  • Personal Care Attendant
  • Las Vegas, NV
  • NPI 1962055228
  NPD Authorized official

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

{
    "created_epoch": "1648684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679529600000",
    "number": "1851031223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2285 RENAISSANCE DR STE B",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891196754",
            "telephone_number": "725-200-6402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2285 RENAISSANCE DR STE B",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891196754",
            "telephone_number": "725-200-6402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYSTIC BEHAVIORAL HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-31",
        "last_updated": "2023-03-23",
        "certification_date": "2023-03-23",
        "status": "A",
        "authorized_official_last_name": "NORWOOD",
        "authorized_official_first_name": "ERICA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "725-200-6402"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mystic Behavioral Health Services",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Mystic Behavioral Health Services",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Community/Behavioral Health Agency in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2023; 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.