Provider Demographics
NPI:1881219848
Name:M&M BEHAVIORAL HEALTH SYSTEMS
Entity Type:Organization
Organization Name:M&M BEHAVIORAL HEALTH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PETER
Authorized Official - Suffix:
Authorized Official - Credentials:CREDENTIALING MANAGE
Authorized Official - Phone:530-868-6944
Mailing Address - Street 1:4105 DAYLILY DR
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5034
Mailing Address - Country:US
Mailing Address - Phone:443-672-7028
Mailing Address - Fax:
Practice Address - Street 1:9613 HARFORD RD
Practice Address - Street 2:STE C #1061
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-2150
Practice Address - Country:US
Practice Address - Phone:410-800-4471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-15
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty