MEDICARE: TENDER MIND & SOUL HEALTHCARE SERVICES 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1093649105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENDER MIND & SOUL HEALTHCARE SERVICES LLC

Provider Business Mailing Address
First Line	:	30 S RITTERS LN
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-3314
Country	:	US
Telephone Number	:	240-714-9910
Fax Number	:	240-714-9910

Provider Business Practice Location Address
First Line	:	872 ELMWOOD CT
Second Line	:
City	:	WESTMINSTER
State	:	MD
Zip	:	21158-8848
Country	:	US
Telephone Number	:	240-714-9910
Fax Number	:	240-714-9910

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DEBORAH OLUWAKEMI BAMIDELE-FALUSI
Credential	:	CRNP-PMH BC
Telephone Number	:	240-714-9910

Provider Enumeration Date	:	06/12/2026
Last Update Date	:	06/12/2026

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