Healthcare Provider Details

I. General information

NPI: 1194442624
Provider Name (Legal Business Name): URBAN OASIS BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 W 36TH ST
BALTIMORE MD
21211-2415
US

IV. Provider business mailing address

5537 SHALLOW RIVER RD
CLINTON MD
20735-1419
US

V. Phone/Fax

Practice location:
  • Phone: 410-881-7363
  • Fax: 410-807-3518
Mailing address:
  • Phone: 917-474-3792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. PHYLLIS FELICIA LEWIS
Title or Position: DIRECTOR
Credential:
Phone: 917-474-3792