Healthcare Provider Details

I. General information

NPI: 1629789227
Provider Name (Legal Business Name): HUMANIM MENTAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6505 RIDENOUR WAY E 1A
ELDERSBURG MD
21784-6557
US

IV. Provider business mailing address

6505 RIDENOUR WAY E # 1A
ELDERSBURG MD
21784-6557
US

V. Phone/Fax

Practice location:
  • Phone: 443-300-6362
  • Fax: 667-400-6110
Mailing address:
  • Phone: 443-300-6362
  • Fax: 667-400-6110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: KACEY LOVE
Title or Position: BILLING COORDINATOR
Credential:
Phone: 410-967-5715