Provider Demographics
NPI:1588400030
Name:PROSPER HEALTH AND BEHAVIORAL CARE SERVICES
Entity type:Organization
Organization Name:PROSPER HEALTH AND BEHAVIORAL CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIANA
Authorized Official - Middle Name:ADA
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-799-4247
Mailing Address - Street 1:3934 RED DEER CIRCLE
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133
Mailing Address - Country:US
Mailing Address - Phone:443-799-4247
Mailing Address - Fax:
Practice Address - Street 1:218 E LEXINGTON ST STE 100
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-3532
Practice Address - Country:US
Practice Address - Phone:443-799-4247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty