Healthcare Provider Details

I. General information

NPI: 1104774736
Provider Name (Legal Business Name): EQUILIBRUM BEHAVIORAL HEALTH &T ELEPSYCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 SHADED BROOK DR
OWINGS MILLS MD
21117-2349
US

IV. Provider business mailing address

2307 SHADED BROOK DR
OWINGS MILLS MD
21117-2349
US

V. Phone/Fax

Practice location:
  • Phone: 916-527-4740
  • Fax:
Mailing address:
  • Phone:
  • 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: MRS. BEATRICE GILZINE-BBACKWOOD
Title or Position: ONWER
Credential: NP
Phone: 916-527-4740