MEDICARE: PSYCYOURMIND CONSULTING, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency	4211379
2	251S00000X	Community/Behavioral Health Agency	0701006872	VA
3	251S00000X	Community/Behavioral Health Agency	LC6912	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487181921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCYOURMIND CONSULTING, LLC

Provider Business Mailing Address
First Line	:	817 SILVER SPRING AVE STE 401C
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-4617
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	817 SILVER SPRING AVE STE 401C
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-4617
Country	:	US
Telephone Number	:	240-398-3936
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CRYSTAL JOSEPH
Credential	:
Telephone Number	:	202-617-1903

Provider Enumeration Date	:	05/15/2017
Last Update Date	:	06/16/2018

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