| Platinum Behavioral Health Llc | |
|
1125 West St Ste 235 Annapolis MD 21401-4198 | |
| (240) 353-1018 | |
| Not Available |
| Full Name | Platinum Behavioral Health Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 1125 West St Ste 235, Annapolis, Maryland |
| Authorized Official Name and Position | Malcolm Cook (NURSE PRACTITIONER) |
| Authorized Official Contact | 2403531018 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Platinum Behavioral Health Llc 2019 S Anvil Ln Temple Hills MD 20748-4286 Ph: (240) 353-1018 | Platinum Behavioral Health Llc 1125 West St Ste 235 Annapolis MD 21401-4198 Ph: (240) 353-1018 |
| NPI Number | 1083244354 |
|---|---|
| Provider Enumeration Date | 01/24/2020 |
| Last Update Date | 10/26/2020 |
| Medicare PECOS PAC ID | 1658701453 |
|---|---|
| Medicare Enrollment ID | O20200418000241 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083244354 | NPI | - | NPPES |
| 15880647208 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
| Provider Name | Malcolm Cook |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588064208 PECOS PAC ID: 1456674266 Enrollment ID: I20200418000272 |
| Provider Name | Kellie Sewell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750411807 PECOS PAC ID: 2961564653 Enrollment ID: I20221006000300 |
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