=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245191097
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OPTIMAL BEHAVIORAL HEALTH SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2025
-----------------------------------------------------
Last Update Date | 12/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7004 SECURITY BLVD STE 300-A36
-----------------------------------------------------
City | WINDSOR MILL
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21244-2557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-591-9884
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4530 TAPSCOTT RD # A
-----------------------------------------------------
City | PIKESVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21208-2245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-564-1823
-----------------------------------------------------
Fax | 410-564-1823
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | KIMBERLY MICHELLE CAMPBELL TYREE
-----------------------------------------------------
Credential | LCPC
-----------------------------------------------------
Telephone | 410-564-1823
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------