Provider Demographics
NPI: | 1225005580 |
---|---|
Name: | EVERLY, HILDRETH & PLATMAN BEHAVIORAL SERVICES, LLC |
Entity Type: | Organization |
Organization Name: | EVERLY, HILDRETH & PLATMAN BEHAVIORAL SERVICES, LLC |
Other - Org Name: | EHP BEHAVIORAL SERVICES, LLC |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OFFICE MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MATT |
Authorized Official - Middle Name: | J |
Authorized Official - Last Name: | KRAWCZYK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 410-933-9000 |
Mailing Address - Street 1: | 1105 N POINT BLVD STE 321 |
Mailing Address - Street 2: | |
Mailing Address - City: | BALTIMORE |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21224-3472 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 410-517-7060 |
Mailing Address - Fax: | 443-407-2942 |
Practice Address - Street 1: | 8114 SANDPIPER CIRCLE |
Practice Address - Street 2: | SUITE 215 |
Practice Address - City: | BALTIMORE |
Practice Address - State: | MD |
Practice Address - Zip Code: | 21236-5902 |
Practice Address - Country: | US |
Practice Address - Phone: | 410-933-9000 |
Practice Address - Fax: | 410-933-0125 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-03-07 |
Last Update Date: | 2023-01-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MD | LC1222 | 101YM0800X |
MD | LC6057 | 101YM0800X |
101YP2500X, 103TC0700X, 103TC1900X, 1041C0700X, 363LP0808X, 364SP0808X | ||
MD | 04877 | 103TC0700X |
MD | D0066852 | 2084P0800X, 2084P0800X |
MD | R121651 | 363LP0808X |
MD | R188329 | 363LP0808X |
MD | R060028 | 364SP0809X |
MD | R032121 | 364SP0809X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
Yes | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Multi-Specialty |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
No | 364SP0808X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health | Group - Multi-Specialty |
No | 364SP0809X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Adult | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MD | 220281600 | Medicaid | |
MD | 148251300 | Medicaid | |
MD | KN76 | Medicare PIN |