Healthcare Provider Details

I. General information

NPI: 1730098179
Provider Name (Legal Business Name): BLUTIDE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 POPPY DR
ABERDEEN MD
21001-1193
US

IV. Provider business mailing address

927 POPPY DR
ABERDEEN MD
21001-1193
US

V. Phone/Fax

Practice location:
  • Phone: 443-466-8850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: TKEYAH MYERS
Title or Position: MENTAL HEALTH THERAPIST
Credential: LCPC
Phone: 443-466-8850