Healthcare Provider Details

I. General information

NPI: 1386022754
Provider Name (Legal Business Name): PHOENIX BEHAVIORAL HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E PULASKI HWY
ELKTON MD
21921-6737
US

IV. Provider business mailing address

PO BOX 428
ELKTON MD
21922-0428
US

V. Phone/Fax

Practice location:
  • Phone: 410-398-0590
  • Fax: 302-595-3149
Mailing address:
  • Phone: 410-398-0590
  • Fax: 302-595-3149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ZAHID ASLAM
Title or Position: MANAGING MEMEBER
Credential: M.D.
Phone: 410-398-0590