Provider Demographics
NPI:1194333179
Name:HALYARD BEHAVIORAL HEALTH & WELLNESS
Entity type:Organization
Organization Name:HALYARD BEHAVIORAL HEALTH & WELLNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
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 1:2415 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5017
Mailing Address - Country:US
Mailing Address - Phone:240-718-8274
Mailing Address - Fax:
Practice Address - Street 1:2415 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5017
Practice Address - Country:US
Practice Address - Phone:240-718-8274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HALYARD BEHAVIORAL HEALTH & WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-16
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty