Provider Demographics
NPI:1255974721
Name:HALYARD BEHAVIORAL HEALTH & WELLNESS, PLLC
Entity type:Organization
Organization Name:HALYARD BEHAVIORAL HEALTH & WELLNESS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TASHICA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:HALYARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, CAC-AD
Authorized Official - Phone:281-508-3604
Mailing Address - Street 1:2415 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5017
Mailing Address - Country:US
Mailing Address - Phone:281-508-3604
Mailing Address - Fax:410-810-2176
Practice Address - Street 1:2415 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5017
Practice Address - Country:US
Practice Address - Phone:240-718-8274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-28
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD184082701Medicaid