Healthcare Provider Details

I. General information

NPI: 1366182529
Provider Name (Legal Business Name): HALYARD BEHAVIORAL HEALTH & WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 03/29/2022
Certification Date: 02/13/2022
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 TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

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