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General NPI Number Information
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NPI Number | 1295258770
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Entity Type | Organization
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Legal Business Name | GREENBROOK TMS HUNT VALLEY LLC
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Dates
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Enumeration Date | 07/17/2017
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Last Update Date | 07/17/2017
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Provider Practice Location Address
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Address Line | 200 INTERNATIONAL CIR STE 1300
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City | HUNT VALLEY
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State | MD
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Zip | 21030-1355
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Country | US
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Telephone | 855-755-4867
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Fax |
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Provider Business Mailing Address
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Address Line | 900 BESTGATE RD STE 102
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City | ANNAPOLIS
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State | MD
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Zip | 21401-3066
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Country | US
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Telephone | 855-755-4867
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Fax |
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Authorized Official
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Title or Position | REGIONAL MANAGER
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Name | MS. EGAN S PRATT
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Credential |
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Telephone | 855-755-4867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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