Healthcare Provider Details

I. General information

NPI: 1134052012
Provider Name (Legal Business Name): INNOVATIVE TREATMENT CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 BAUGHMANS LN STE 270
FREDERICK MD
21702-4650
US

IV. Provider business mailing address

110 BAUGHMANS LN STE 270
FREDERICK MD
21702-4650
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 Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TRAVIS A BAIRD
Title or Position: CEO
Credential:
Phone: 443-430-2998