Healthcare Provider Details

I. General information

NPI: 1265017347
Provider Name (Legal Business Name): BE-LIVE-IT THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 N BROADWAY STE 101
BALTIMORE MD
21213-1444
US

IV. Provider business mailing address

7207 BALTIMORE ANNAPOLIS BLVD
GLEN BURNIE MD
21061-2684
US

V. Phone/Fax

Practice location:
  • Phone: 410-366-1893
  • Fax:
Mailing address:
  • Phone: 410-766-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BECKY TATANI
Title or Position: CEO
Credential:
Phone: 410-766-7300