Provider Demographics
NPI:1720860265
Name:MIDSHORE MENTAL HEALTH
Entity Type:Organization
Organization Name:MIDSHORE MENTAL HEALTH
Other - Org Name:SHORE MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:CALLAHAN
Authorized Official - Last Name:HULSEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:828-318-2873
Mailing Address - Street 1:8133 ELLIOTT RD STE 102
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-7184
Mailing Address - Country:US
Mailing Address - Phone:828-318-2873
Mailing Address - Fax:
Practice Address - Street 1:8133 ELLIOTT RD STE 102
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7184
Practice Address - Country:US
Practice Address - Phone:828-318-2873
Practice Address - Fax:443-440-5072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-18
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1144667957OtherNPI