Provider Demographics
NPI:1346953304
Name:ESSENE BEHAVIORAL HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:ESSENE BEHAVIORAL HEALTHCARE SERVICES
Other - Org Name:ESSENE BEHAVIORAL HEALTHCARE,LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRECIOUS
Authorized Official - Middle Name:
Authorized Official - Last Name:ESENE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, CNP-PMH, PMHNP-
Authorized Official - Phone:240-334-7174
Mailing Address - Street 1:14502 GREENVIEW DR STE 432
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3287
Mailing Address - Country:US
Mailing Address - Phone:240-334-7147
Mailing Address - Fax:949-655-6061
Practice Address - Street 1:14502 GREENVIEW DR STE 432
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3287
Practice Address - Country:US
Practice Address - Phone:240-334-7147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-04
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0000000OtherIN PROCESS