| Beulahspring Behavioral Health Services Llc | |
|
13908 Edsall St Upper Marlboro MD 20772-6849 | |
| (240) 602-7099 | |
| Not Available |
| Full Name | Beulahspring Behavioral Health Services Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 13908 Edsall St, Upper Marlboro, Maryland |
| Authorized Official Name and Position | Regina Ekong (PROVIDER) |
| Authorized Official Contact | 2406027099 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Beulahspring Behavioral Health Services Llc 13908 Edsall St Upper Marlboro MD 20772-6849 Ph: (240) 602-7099 | Beulahspring Behavioral Health Services Llc 13908 Edsall St Upper Marlboro MD 20772-6849 Ph: (240) 602-7099 |
| NPI Number | 1790492270 |
|---|---|
| Provider Enumeration Date | 11/03/2022 |
| Last Update Date | 11/03/2022 |
| Certification Date | 11/03/2022 |
| Medicare PECOS PAC ID | 8123490364 |
|---|---|
| Medicare Enrollment ID | O20230215003209 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790492270 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Regina Ekong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336591981 PECOS PAC ID: 9032581277 Enrollment ID: I20230215003213 |
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