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General NPI Number Information
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NPI Number | 1396392452
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Entity Type | Organization
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Legal Business Name | STAYWELL BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 08/23/2019
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Last Update Date | 08/23/2019
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Provider Practice Location Address
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Address Line | 10451 MILL RUN CIR STE 400
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City | OWINGS MILLS
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State | MD
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Zip | 21117-5594
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Country | US
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Telephone | 443-525-1495
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 28
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City | ABINGDON
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State | MD
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Zip | 21009-0028
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Country | US
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Telephone | 410-569-4165
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | PAM WATFORD
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Credential | MANAGER
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Telephone | 410-569-4165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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