Provider Demographics
NPI:1851630586
Name:HEALTHY MINDS THERAPEUTIC SERVICES, LLC
Entity Type:Organization
Organization Name:HEALTHY MINDS THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:N
Authorized Official - Last Name:HERRON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-227-9426
Mailing Address - Street 1:2901 DRUID PARK DR
Mailing Address - Street 2:SUITE A202
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-8102
Mailing Address - Country:US
Mailing Address - Phone:410-227-9426
Mailing Address - Fax:
Practice Address - Street 1:2901 DRUID PARK DRIVE
Practice Address - Street 2:SUITE A202
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215
Practice Address - Country:US
Practice Address - Phone:410-227-9426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD158511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD038385Medicaid