Provider Demographics
NPI:1528448404
Name:HEALTHY MINDS RESOURCE SERVICES
Entity type:Organization
Organization Name:HEALTHY MINDS RESOURCE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFINIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-363-3713
Mailing Address - Street 1:500 REDLAND CT
Mailing Address - Street 2:STE 213
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3264
Mailing Address - Country:US
Mailing Address - Phone:410-625-5088
Mailing Address - Fax:
Practice Address - Street 1:1800 N CHARLES ST
Practice Address - Street 2:STE 804
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5920
Practice Address - Country:US
Practice Address - Phone:410-363-3713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDATC110101YP2500X
MDLC3003101YP2500X
MD404629300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404629300Medicaid