Healthcare Provider Details

I. General information

NPI: 1275956377
Provider Name (Legal Business Name): TIME OUTPATIENT MENTAL HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2014
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 DRUID PARK DR STE A210
BALTIMORE MD
21215-8137
US

IV. Provider business mailing address

2901 DRUID PARK DR STE A202
BALTIMORE MD
21215-8131
US

V. Phone/Fax

Practice location:
  • Phone: 410-225-0062
  • Fax: 410-225-0184
Mailing address:
  • Phone: 410-225-0062
  • Fax: 410-225-0184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. LAUREN N HERRON
Title or Position: CLINICAL DIRECTOR
Credential: LCSW-C
Phone: 410-227-9426