MEDICARE: RESPAWN COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1063378362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESPAWN COUNSELING LLC

Provider Business Mailing Address
First Line	:	566 FOREST VIEW RD
Second Line	:
City	:	LINTHICUM HEIGHTS
State	:	MD
Zip	:	21090-2818
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	566 FOREST VIEW RD
Second Line	:
City	:	LINTHICUM HEIGHTS
State	:	MD
Zip	:	21090-2818
Country	:	US
Telephone Number	:	443-927-6746
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TIMOTHY DAVID PERRY
Credential	:	LCPC
Telephone Number	:	443-927-6746

Provider Enumeration Date	:	12/30/2025
Last Update Date	:	12/30/2025

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