Healthcare Provider Details

I. General information

NPI: 1821879651
Provider Name (Legal Business Name): MYK PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 WASHINGTON HEIGHTS MED CTR
WESTMINSTER MD
21157-5633
US

IV. Provider business mailing address

220 WASHINGTON HEIGHTS MED CTR
WESTMINSTER MD
21157-5633
US

V. Phone/Fax

Practice location:
  • Phone: 410-861-6362
  • Fax: 443-281-6379
Mailing address:
  • Phone: 410-861-6362
  • Fax: 443-281-6379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MANDI RHONE
Title or Position: OWNER
Credential: CRNP
Phone: 410-861-6363