Healthcare Provider Details

I. General information

NPI: 1104756543
Provider Name (Legal Business Name): INNOVATIVE TREATMENT CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 BAUGHMANS LN STE 270
FREDERICK MD
21702-4650
US

IV. Provider business mailing address

325 HOSPITAL DR STE 106
GLEN BURNIE MD
21061-5806
US

V. Phone/Fax

Practice location:
  • Phone: 443-430-2998
  • Fax:
Mailing address:
  • Phone: 443-430-2998
  • 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: TRAVIS A BAIRD
Title or Position: CEO, OWNER
Credential: PMHNP, CRNP
Phone: 443-430-2998