| NPI | 1851031223 |
|---|---|
| Former Legal Business Name | MYSTIC BEHAVIORAL HEALTH SERVICES |
| Entity Type | Organization |
| Authorized Contact | ERICA NORWOOD CEO 725-200-6402 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Enumeration Date | 2022-03-31 |
| Last Update Date | 2023-03-23 |