NPIMap

Organization Active NPI

Lucid Psychiatric Practice LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Towson, MD
National Provider Identifier
1235660457
Registry record updated May 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
R184691 Issued in MD
Legal business name
LUCID PSYCHIATRIC PRACTICE LLC
Practice address
1200 E Joppa Rd
Suite a
Towson, MD 21286-5810
Phone
(443) 632-9302
Fax
(443) 798-2772
NPI assigned
Mar 21, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2017

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

Authorized official

Name
Brian AndersonNPI 1427499300
Title
Owner
Phone
(301) 351-1061

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
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X R184691 MD Primary

Addresses

Primary practice location

1200 E Joppa Rd
Suite a
Towson, MD 21286-5810

Mailing address

1200 E Joppa Rd
Suite a
Towson, MD 21286-5810

Other names 1

  • Centered Counseling Services, Inc. Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170818001897 MD Part B Supplier - Clinic/Group Practice 5092087445 Receives reassigned benefits from 7 practitioners
Practice locations: Towson, MD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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": "1490054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493856000000",
    "number": "1235660457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 E JOPPA RD",
            "address_2": "SUITE A",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212865810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 E JOPPA RD",
            "address_2": "SUITE A",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212865810",
            "telephone_number": "443-632-9302",
            "fax_number": "443-798-2772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUCID PSYCHIATRIC PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-21",
        "last_updated": "2017-05-04",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-351-1061"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R184691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Centered Counseling Services, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Towson, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.