| 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 - Psychiatric/mental Health |
| Location | 1125 West St Ste 235, Annapolis, Maryland |
| Authorized Official Name and Position | Malcolm Cook (NURSE PRACTITIONER) |
| Authorized Official Contact | 2403531018 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| 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 |
| Certification Date | 10/26/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083244354 | NPI | - | NPPES |
| 15880647208 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | () | Primary |
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