Provider Demographics
NPI:1194415901
Name:HALYARD BEHAVIORAL HEALTH & WELLNESS
Entity type:Organization
Organization Name:HALYARD BEHAVIORAL HEALTH & WELLNESS
Other - Org Name:
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:LCPC
Authorized Official - Phone:281-508-3604
Mailing Address - Street 1:340 E UNIVERSITY PKWY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2845
Mailing Address - Country:US
Mailing Address - Phone:281-508-3604
Mailing Address - Fax:
Practice Address - Street 1:800 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-1621
Practice Address - Country:US
Practice Address - Phone:240-718-8274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251B00000XAgenciesCase Management