Healthcare Provider Details

I. General information

NPI: 1568397883
Provider Name (Legal Business Name): TIDE BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9277 CARTERSVILLE RD
COLUMBIA MD
21046-1603
US

IV. Provider business mailing address

9277 CARTERSVILLE RD
COLUMBIA MD
21046-1603
US

V. Phone/Fax

Practice location:
  • Phone: 262-271-1143
  • Fax:
Mailing address:
  • Phone: 443-563-7091
  • 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 State

VIII. Authorized Official

Name: IDI USMAN
Title or Position: PRESIDENT
Credential:
Phone: 443-563-7091