Provider Demographics
NPI:1144911603
Name:TAS BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:TAS BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NKONGCHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-599-5177
Mailing Address - Street 1:4300 CEDAR REACH LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-5808
Mailing Address - Country:US
Mailing Address - Phone:240-599-5177
Mailing Address - Fax:
Practice Address - Street 1:33 W FRANKLIN ST STE 201
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-4863
Practice Address - Country:US
Practice Address - Phone:240-599-5177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty