Provider Demographics
NPI:1346018538
Name:GLEE MENTAL HEALTH LLC
Entity Type:Organization
Organization Name:GLEE MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ISHMAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ARVIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:443-902-6609
Mailing Address - Street 1:3030 GREENMOUNT AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-6906
Mailing Address - Country:US
Mailing Address - Phone:443-902-6609
Mailing Address - Fax:443-251-4439
Practice Address - Street 1:3030 GREENMOUNT AVE STE 280
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-6906
Practice Address - Country:US
Practice Address - Phone:443-902-6609
Practice Address - Fax:443-251-4439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health