Healthcare Provider Details

I. General information

NPI: 1629520762
Provider Name (Legal Business Name): URBAN BEHAVIORAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16701 MELFORD BLVD STE 400
BOWIE MD
20715-4411
US

IV. Provider business mailing address

16701 MELFORD BLVD
BOWIE MD
20715-4305
US

V. Phone/Fax

Practice location:
  • Phone: 202-836-7776
  • Fax:
Mailing address:
  • Phone: 28-367-7762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberMH2244
License Number StateMD

VIII. Authorized Official

Name: TRACEE BURROUGHS
Title or Position: CEO
Credential:
Phone: 410-779-3102