MEDICARE: MINDSCAPE BEHAVIORAL HEALTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1205592417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDSCAPE BEHAVIORAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	15923 CUTTEN RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-2069
Country	:	US
Telephone Number	:	301-746-2621
Fax Number	:

Provider Business Practice Location Address
First Line	:	15923 CUTTEN RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-2069
Country	:	US
Telephone Number	:	301-746-2621
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	VANISE A LUSH
Credential	:
Telephone Number	:	301-746-2621

Provider Enumeration Date	:	11/11/2021
Last Update Date	:	11/11/2021

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Directions to “MINDSCAPE BEHAVIORAL HEALTH SERVICES ” Practice Location

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