Healthcare Provider Details

I. General information

NPI: 1356104327
Provider Name (Legal Business Name): BEYOND THERAPY BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2024
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 MILFORD MILL RD STE 202
PIKESVILLE MD
21208-5903
US

IV. Provider business mailing address

201 MILFORD MILL RD STE 202
PIKESVILLE MD
21208-5903
US

V. Phone/Fax

Practice location:
  • Phone: 443-842-5104
  • Fax: 443-898-6911
Mailing address:
  • Phone: 443-842-5104
  • Fax: 443-898-6911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANGEL HARP-WITHERSPOON
Title or Position: OWNERR
Credential: LCPC-S
Phone: 410-776-8639