Healthcare Provider Details

I. General information

NPI: 1760302384
Provider Name (Legal Business Name): TYLAR B'S HEALING WITH HOPE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 WOODFORD PL APT D
GWYNN OAK MD
21207-5571
US

IV. Provider business mailing address

3104 WOODFORD PL APT D
GWYNN OAK MD
21207-5571
US

V. Phone/Fax

Practice location:
  • Phone: 443-787-0861
  • Fax:
Mailing address:
  • Phone: 443-787-0861
  • 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: TAKIYSHA TYNES
Title or Position: OWNER
Credential:
Phone: 443-787-0861