Healthcare Provider Details

I. General information

NPI: 1356208151
Provider Name (Legal Business Name): MYSTIC MASSAGE & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 LONG BEACH BLVD # 150
LONG BEACH CA
90807-2617
US

IV. Provider business mailing address

4000 LONG BEACH BLVD # 150
LONG BEACH CA
90807-2617
US

V. Phone/Fax

Practice location:
  • Phone: 562-290-3169
  • Fax:
Mailing address:
  • Phone: 562-290-3169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: SCOTT BEACHLEY
Title or Position: CEO
Credential: LMT
Phone: 562-290-3169