Healthcare Provider Details

I. General information

NPI: 1548027329
Provider Name (Legal Business Name): MENTAL HEALTH CONCEPTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MARBLEDALE CT
REISTERSTOWN MD
21136-3210
US

IV. Provider business mailing address

2 MARBLEDALE CT
REISTERSTOWN MD
21136-3210
US

V. Phone/Fax

Practice location:
  • Phone: 443-983-3211
  • Fax:
Mailing address:
  • Phone: 443-983-3211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CASSANDRA BURKS
Title or Position: OWNER
Credential: PMHNP
Phone: 443-983-3211