Organization · NPI-2

Lifespan Behavioral Health Services PC

Clinic/Center, Mental Health (Including Community Mental Health Center) · Olney, MD

NPI number1114673308
StatusActive
Last updated in NPPESOct 2, 2023

Details

NPI
1114673308
Entity type
Organization (NPI-2)
Legal business name
Lifespan Behavioral Health Services PC
Organization subpart
Yes
Enumeration date
Feb 25, 2022
Certification date
Oct 2, 2023
Last updated
Oct 2, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center)––Yes

Other names

  • Lifespan Behavioral Health Services PC (Former Legal Business Name)

Practice location

3460 Olney Laytonsville Rd Ste 212
Olney, MD 20832-3701

Phone 301-982-3437 · Fax 301-982-9452

Mailing address

3416 Olandwood Ct Ste 201
Olney, MD 20832-1373

Phone 301-969-4060 · Fax 301-982-9452

Authorized official

Joshua Sussal
MD/ Ceo
3019823437

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