MEDICARE: HALYARD BEHAVIORAL HEALTH AND WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1215516349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HALYARD BEHAVIORAL HEALTH AND WELLNESS

Provider Business Mailing Address
First Line	:	2415 MARYLAND AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-5017
Country	:	US
Telephone Number	:	240-718-8274
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 E UNIVERSITY PKWY
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-2845
Country	:	US
Telephone Number	:	240-718-8274
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	TASHICA MONIQUE HALYARD
Credential	:	LCPC
Telephone Number	:	281-508-3604

Provider Enumeration Date	:	04/06/2021
Last Update Date	:	04/29/2021

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