Provider Demographics
NPI:1639501448
Name:BEHAVIORAL HEALTH NETWORK LLC
Entity Type:Organization
Organization Name:BEHAVIORAL HEALTH NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUDAK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-576-9191
Mailing Address - Street 1:201 N CHARLES ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-4102
Mailing Address - Country:US
Mailing Address - Phone:410-576-9191
Mailing Address - Fax:410-576-9257
Practice Address - Street 1:1101 W. PRATT STREET
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223
Practice Address - Country:US
Practice Address - Phone:410-576-9191
Practice Address - Fax:410-576-9257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty