MEDICARE: PENUEL BEHAVIORAL HEALTH SERVICES 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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1548108053
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENUEL BEHAVIORAL HEALTH SERVICES LLC.

Provider Business Mailing Address
First Line	:	4407 HENDERSON RD
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-3615
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4407 HENDERSON RD
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-3615
Country	:	US
Telephone Number	:	301-635-1240
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	OLABIMPE OLOJO
Credential	:
Telephone Number	:	301-635-1240

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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