MEDICARE: AZALEA MENTAL HEALTH 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1912571530	OTHER		NPI

General Provider Information

NPI Number	:	1568115830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AZALEA MENTAL HEALTH LLC

Provider Business Mailing Address
First Line	:	1209A N EAST ST # 106
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21701-4624
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1209A N EAST ST # 106
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21701-4624
Country	:	US
Telephone Number	:	240-788-4812
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARY FRANCES LAHOOD
Credential	:	LCSW-C
Telephone Number	:	240-788-4812

Provider Enumeration Date	:	01/27/2022
Last Update Date	:	01/28/2026

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