Provider Demographics
NPI:1063971471
Name:HALYARD BEHAVIORAL HEALTH & WELLNESS, PLLC
Entity type:Organization
Organization Name:HALYARD BEHAVIORAL HEALTH & WELLNESS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TASHICA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:HALYARD
Authorized Official - Suffix:
Authorized Official - Credentials:LGPC
Authorized Official - Phone:281-508-3604
Mailing Address - Street 1:124 TRENTON ST UNIT 101
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-5078
Mailing Address - Country:US
Mailing Address - Phone:281-508-3604
Mailing Address - Fax:
Practice Address - Street 1:4710 AUTH PL STE 100
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-4223
Practice Address - Country:US
Practice Address - Phone:281-508-3604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-15
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)