Provider Demographics
NPI:1710715685
Name:HOLYSTIK BEHAVIORAH HEALTH
Entity type:Organization
Organization Name:HOLYSTIK BEHAVIORAH HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:OSEGHALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-219-1046
Mailing Address - Street 1:210 CASTLETON PL
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1446
Mailing Address - Country:US
Mailing Address - Phone:301-219-1046
Mailing Address - Fax:
Practice Address - Street 1:210 CASTLETON PL
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-1446
Practice Address - Country:US
Practice Address - Phone:301-219-1046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty