Organization
ONE22 CRAFT ADVISORS CORPORATION
Active
Other names
Miracle Minds Managed Care
Organization subpart
No
Provider details
NPI number
Authorized official
MONTAVIAN MORROW SR. (CEO)
(214) 566-9833
Entity
Organization
Contact information
Practice address
626 E JEFFERSON AVE, BASTROP, LA 71220-4619
(214) 566-9833
Mailing address
2824 GOOSEBERRY DR, PLANO, TX 75074-2044
(214) 566-9833
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
276400000X
Substance Use Disorder Rehabilitation Hospital Unit
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
—
—
385H00000X
Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
BH0011581
—
LA
Enumeration date
02/27/2020
Last updated
02/27/2020
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