One22 Craft Advisors Corporation

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

ONE22 CRAFT ADVISORS CORPORATION

Doing business as

Miracle Minds Managed Care

Practice address

626 E Jefferson Ave
Bastrop, LA 71220-4619

Phone

(214) 566-9833

NPI assigned

Feb 27, 2020

Last updated

Feb 27, 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

Montavian Morrow Sr.

Title

Ceo

Phone

(214) 566-9833

Specialties & licenses 6

Addresses

Other identifiers 1

Other names 1

• Miracle Minds Managed Care Doing business as

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

{
    "created_epoch": "1582761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582761600000",
    "number": "1952935942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2824 GOOSEBERRY DR",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750742044",
            "telephone_number": "214-566-9833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "626 E JEFFERSON AVE",
            "city": "BASTROP",
            "state": "LA",
            "postal_code": "712204619",
            "telephone_number": "214-566-9833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ONE22 CRAFT ADVISORS CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-27",
        "last_updated": "2020-02-27",
        "certification_date": "2020-02-27",
        "status": "A",
        "authorized_official_last_name": "MORROW",
        "authorized_official_first_name": "MONTAVIAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "214-566-9833",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "276400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation, Substance Use Disorder Unit",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "BH0011581",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Miracle Minds Managed Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Behavioral Health Agency in Bastrop, LA
• Providers in Bastrop, LA by specialty
• Community/Behavioral Health Agency in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 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.