Provider Demographics
NPI:1275956377
Name:TIME OUTPATIENT MENTAL HEALTH CLINIC
Entity Type:Organization
Organization Name:TIME OUTPATIENT MENTAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:N
Authorized Official - Last Name:HERRON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-227-9426
Mailing Address - Street 1:2901 DRUID PARK DR STE A202
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-8131
Mailing Address - Country:US
Mailing Address - Phone:410-225-0062
Mailing Address - Fax:410-225-0184
Practice Address - Street 1:2901 DRUID PARK DR STE A210
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-8137
Practice Address - Country:US
Practice Address - Phone:410-225-0062
Practice Address - Fax:410-225-0184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-24
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD421961901Medicaid