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NPI Code Detail

MEDICARE: THERAPEUTIC BEHAVIORAL DYNAMICS LLC

MEDICARE: THERAPEUTIC BEHAVIORAL DYNAMICS 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
1261QM0850XAdult Mental Health Clinic/Center
2171M00000XCase Manager/Care Coordinator
3261QM0855XAdolescent and Children Mental Health Clinic/Center
4261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
5251S00000XCommunity/Behavioral Health Agency
6101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1376412411
Entity Type Code : Organization
Provider Name (Legal Business Name) : THERAPEUTIC BEHAVIORAL DYNAMICS LLC
Provider Business Mailing Address
First Line : 3261 OLD WASHINGTON RD STE 2031
Second Line :
City : WALDORF
State : MD
Zip : 20602-3313
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3261 OLD WASHINGTON RD STE 2031
Second Line :
City : WALDORF
State : MD
Zip : 20602-3313
Country : US
Telephone Number : 301-615-4150
Fax Number :
Authorized Official
Title or Position : MANAGING MEMBER
Name : TIFFANY YOUNGER BANKS
Credential :
Telephone Number : 301-615-4150
Provider Enumeration Date : 11/04/2025
Last Update Date : 11/13/2025

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