MEDICARE: PRUDENT MINDS BEHAVIORAL HEALTH

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1861192593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRUDENT MINDS BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	15614 MEWS CT
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20707-3311
Country	:	US
Telephone Number	:	301-793-1775
Fax Number	:

Provider Business Practice Location Address
First Line	:	15614 MEWS CT
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20707-3311
Country	:	US
Telephone Number	:	301-793-1775
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. RABIATU BANGURA
Credential	:
Telephone Number	:	301-793-1775

Provider Enumeration Date	:	03/10/2023
Last Update Date	:	04/16/2024

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