1366552333 NPI number — INSIGHT BEHAVIORAL HEALTH, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366552333 NPI number — INSIGHT BEHAVIORAL HEALTH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSIGHT BEHAVIORAL HEALTH, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366552333
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
390 MAPLE TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CROWNSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21032-1729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-905-2808
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1831B FOREST DR STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-4429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-280-0990
Provider Business Practice Location Address Fax Number:
410-280-0990
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WETMORE
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
BANKS
Authorized Official Title or Position:
THERAPIST/SOLE PROPRIETOR
Authorized Official Telephone Number:
410-280-0990

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , with the licence number:  12570 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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