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General NPI Number Information
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NPI Number | 1265017347
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Entity Type | Organization
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Legal Business Name | BE-LIVE-IT THERAPY
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Dates
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Enumeration Date | 03/10/2021
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Last Update Date | 03/10/2021
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Provider Practice Location Address
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Address Line | 1910 N BROADWAY STE 101
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City | BALTIMORE
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State | MD
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Zip | 21213-1444
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Country | US
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Telephone | 410-366-1893
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Fax |
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Provider Business Mailing Address
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Address Line | 7207 BALTIMORE ANNAPOLIS BLVD
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City | GLEN BURNIE
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State | MD
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Zip | 21061-2684
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Country | US
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Telephone | 410-766-7300
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BECKY TATANI
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Credential |
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Telephone | 410-766-7300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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