Provider Demographics
NPI:1982223194
Name:MIGHTY BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:MIGHTY BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BISRAT
Authorized Official - Middle Name:
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 600
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-1711
Mailing Address - Country:US
Mailing Address - Phone:667-260-2933
Mailing Address - Fax:667-660-2167
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:667-260-2933
Practice Address - Fax:667-660-2167
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIGHTY BEHAVIORAL HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health