Provider Demographics
NPI:1720569882
Name:MIGHTY BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:MIGHTY BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BISRAT
Authorized Official - Middle Name:A
Authorized Official - Last Name:MESFIN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP-PMH
Authorized Official - Phone:512-947-2747
Mailing Address - Street 1:11 E LEXINGTON ST STE 400
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-1723
Mailing Address - Country:US
Mailing Address - Phone:443-708-5162
Mailing Address - Fax:410-826-3855
Practice Address - Street 1:11 E LEXINGTON ST STE 600
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-1711
Practice Address - Country:US
Practice Address - Phone:443-226-3330
Practice Address - Fax:410-826-3855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-27
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD742010200Medicaid