Healthcare Provider Details

I. General information

NPI: 1487262473
Provider Name (Legal Business Name): HALYARD BEHAVIORAL HEALTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 12/14/2020
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 MARYLAND AVE
BALTIMORE MD
21218-5017
US

IV. Provider business mailing address

2415 MARYLAND AVE
BALTIMORE MD
21218-5017
US

V. Phone/Fax

Practice location:
  • Phone: 240-718-8274
  • Fax:
Mailing address:
  • Phone: 240-718-8274
  • Fax:

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 Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. TASHICA MONIQUE HALYARD
Title or Position: CEO
Credential: LCPC
Phone: 281-508-3604