Healthcare Provider Details

I. General information

NPI: 1235996786
Provider Name (Legal Business Name): SPEAK EASY MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 W LAFAYETTE AVE STE D
BALTIMORE MD
21216-4804
US

IV. Provider business mailing address

439 LAUREL OAK LN
SEVEN VALLEYS PA
17360-8721
US

V. Phone/Fax

Practice location:
  • Phone: 410-793-4777
  • Fax: 443-267-0084
Mailing address:
  • Phone: 443-797-2364
  • Fax: 443-267-0084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. BRITTANY RAQUEL JOHNSON
Title or Position: NURSE PRACTITIONER
Credential: PMHNP-BC
Phone: 443-797-2364