Provider Demographics
NPI:1427676758
Name:HALYARD BEHAVIORAL HEALTH AND WELLNESS
Entity type:Organization
Organization Name:HALYARD BEHAVIORAL HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
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 1:2415 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:281-508-3604
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:281-508-3604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HALYARD BEHAVIORAL HEALTH & WELLNESS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD184082701Medicaid