NPIMap

Organization Active NPI

Lifespan Behavioral Health Services PC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Olney, MD
National Provider Identifier
1114673308
Registry record updated Oct 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
LIFESPAN BEHAVIORAL HEALTH SERVICES PC
Practice address
3460 Olney Laytonsville Rd Ste 212
Olney, MD 20832-3701
Phone
(301) 982-3437
Fax
(301) 982-9452
NPI assigned
Feb 25, 2022
Organization subpart
Yes
Parent organization
LIFESPAN BEHAVIORAL HEALTH SERVICES PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 2, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joshua SussalNPI 1922212174
Title
MD/ Ceo
Phone
(301) 982-3437

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

3460 Olney Laytonsville Rd Ste 212
Olney, MD 20832-3701

Mailing address

3416 Olandwood CT Ste 201
Olney, MD 20832-1373
Phone (301) 969-4060

Other names 1

  • Lifespan Behavioral Health Services PC Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Lifespan Behavioral Health4 organizations share this tax ID, including this one
Part of
Lifespan Behavioral Health

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3410 Olney Laytonsville Rd
Ste 212
Olney, MD 20832
Phone (301) 969-4060

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1645747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696204800000",
    "number": "1114673308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3416 OLANDWOOD CT STE 201",
            "city": "OLNEY",
            "state": "MD",
            "postal_code": "208321373",
            "telephone_number": "301-969-4060",
            "fax_number": "301-982-9452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3460 OLNEY LAYTONSVILLE RD STE 212",
            "city": "OLNEY",
            "state": "MD",
            "postal_code": "208323701",
            "telephone_number": "301-982-3437",
            "fax_number": "301-982-9452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESPAN BEHAVIORAL HEALTH SERVICES PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFESPAN BEHAVIORAL HEALTH SERVICES PC",
        "enumeration_date": "2022-02-25",
        "last_updated": "2023-10-02",
        "certification_date": "2023-10-02",
        "status": "A",
        "authorized_official_last_name": "SUSSAL",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "MD/ CEO",
        "authorized_official_telephone_number": "301-982-3437"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lifespan Behavioral Health Services PC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Lifespan Behavioral Health Services PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Olney, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.