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NPI Code Detail

MEDICARE: PENUEL BEHAVIORAL HEALTH SERVICES LLC.

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
1103T00000XPsychologist

General Provider Information

NPI Number : 1689512105
Entity Type Code : Organization
Provider Name (Legal Business Name) : PENUEL BEHAVIORAL HEALTH SERVICES LLC.
Provider Business Mailing Address
First Line : 9708 MONROE ST STE 201
Second Line :
City : COCKEYSVILLE
State : MD
Zip : 21030-5081
Country : US
Telephone Number : 301-795-9450
Fax Number :
Provider Business Practice Location Address
First Line : 9708 MONROE ST STE 201
Second Line :
City : COCKEYSVILLE
State : MD
Zip : 21030-5081
Country : US
Telephone Number : 301-795-9450
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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