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General NPI Number Information
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NPI Number | 1477362861
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Entity Type | Organization
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Legal Business Name | MYTHICAL WELLNESS
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Dates
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Enumeration Date | 12/31/2024
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 1000 WILLOW CREEK RD STE C
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City | PRESCOTT
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State | AZ
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Zip | 86301-1645
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Country | US
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Telephone | 928-362-0577
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Fax | 928-916-5441
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Provider Business Mailing Address
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Address Line | 1000 WILLOW CREEK RD STE C
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City | PRESCOTT
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State | AZ
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Zip | 86301-1645
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Country | US
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Telephone | 928-362-0577
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Fax | 928-916-5441
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | VICTORIA ANGEL
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Credential | FNP-BC
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Telephone | 928-362-0577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207QH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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