Healthcare Provider Details

I. General information

NPI: 1407436330
Provider Name (Legal Business Name): BREATHE FREELY BEHAVIORAL HEALTH SYSTEMS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 BELAIR RD STE 1A1B
BALTIMORE MD
21206-1855
US

IV. Provider business mailing address

6600 BELAIR RD
BALTIMORE MD
21206-1855
US

V. Phone/Fax

Practice location:
  • Phone: 443-300-7261
  • Fax:
Mailing address:
  • Phone: 410-670-9861
  • Fax:

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: TANIKA WALKER
Title or Position: CEO
Credential:
Phone: 410-670-9861