Healthcare Provider Details

I. General information

NPI: 1902764939
Provider Name (Legal Business Name): FREDERICK BEHAVIORAL HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10212 GOVERNOR LANE BLVD UNIT 1006
WILLIAMSPORT MD
21795-4088
US

IV. Provider business mailing address

5100 BUCKEYSTOWN PIKE STE 250
FREDERICK MD
21704-8344
US

V. Phone/Fax

Practice location:
  • Phone: 301-321-8245
  • Fax: 301-238-7915
Mailing address:
  • Phone: 301-321-8245
  • Fax: 301-238-2915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: THOMAS WILLIAM COLLIGAN JR.
Title or Position: OWNER, CEO
Credential:
Phone: 301-321-8245