Provider Demographics
NPI:1508862392
Name:BLUE RIDGE BEHAVIORAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:BLUE RIDGE BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEPEONKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-695-8390
Mailing Address - Street 1:170 THOMAS JOHNSON DR
Mailing Address - Street 2:STE 200
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-6200
Mailing Address - Country:US
Mailing Address - Phone:301-695-8390
Mailing Address - Fax:301-694-7906
Practice Address - Street 1:170 THOMAS JOHNSON DR
Practice Address - Street 2:STE 200
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-6200
Practice Address - Country:US
Practice Address - Phone:301-695-8390
Practice Address - Fax:301-694-7906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-26
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD580LMedicare ID - Type UnspecifiedMEDICARE