Provider Demographics
NPI: | 1508629486 |
---|---|
Name: | BEYOND THERAPY BEHAVIORAL HEALTH, LLC |
Entity Type: | Organization |
Organization Name: | BEYOND THERAPY BEHAVIORAL HEALTH, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ANGEL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HARP-WITHERSPOON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LCPC-S |
Authorized Official - Phone: | 410-776-8639 |
Mailing Address - Street 1: | 201 MILFORD MILL RD STE 202 |
Mailing Address - Street 2: | |
Mailing Address - City: | PIKESVILLE |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21208-5903 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 443-842-5104 |
Mailing Address - Fax: | 443-898-6911 |
Practice Address - Street 1: | 201 MILFORD MILL RD STE 202 |
Practice Address - Street 2: | |
Practice Address - City: | PIKESVILLE |
Practice Address - State: | MD |
Practice Address - Zip Code: | 21208-5903 |
Practice Address - Country: | US |
Practice Address - Phone: | 443-842-5104 |
Practice Address - Fax: | 443-898-6911 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | BEYOND THERAPY BEHAVIORAL HEALTH, LLC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2024-02-02 |
Last Update Date: | 2024-02-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health |