Provider Demographics
NPI:1821842774
Name:FORMATIONS HEALTH
Entity Type:Organization
Organization Name:FORMATIONS HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO OF FORMATIONS HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:TEKESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:TYSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-846-9239
Mailing Address - Street 1:710 N HAMMONDS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:21090-1313
Mailing Address - Country:US
Mailing Address - Phone:410-636-7057
Mailing Address - Fax:
Practice Address - Street 1:710 N HAMMONDS FERRY RD
Practice Address - Street 2:
Practice Address - City:LINTHICUM HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:21090-1313
Practice Address - Country:US
Practice Address - Phone:410-636-7057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty