NPIMap

Organization Active NPI

Carroll County Youth Service Bureau, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Westminster, MD
National Provider Identifier
1710042924
Registry record updated Feb 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
12225 Issued in MD
Legal business name
CARROLL COUNTY YOUTH SERVICE BUREAU, INC.
Practice address
59 Kate Wagner Rd.
Westminster, MD 21157
Phone
(410) 848-2500
Fax
(410) 876-3016
NPI assigned
Dec 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2023

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

Authorized official

Name
Lynn Davis, LCPC
Title
Executive Director
Phone
(443) 244-8649

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 12225 MD Primary

Addresses

Primary practice location

59 Kate Wagner Rd.
Westminster, MD 21157

Mailing address

59 Kate Wagner Rd
Westminster, MD 21157-6957
Phone (410) 848-2500

Other identifiers 1

IdentifierTypeStateIssuer
615501400MedicaidMD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040826001093 MD Part B Supplier - Clinic/Group Practice 2365417052 Receives reassigned benefits from 16 practitioners
Practice locations: Westminster, MD

National Provider Directory

National Provider Directory
Tax ID family
Carroll County Youth Service Bureau Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

180 Kriders Church Rd
Westminster, MD 21158
Phone (410) 848-4124

Practitioners & affiliated clinicians

Practitioners 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676419200000",
    "number": "1710042924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "59 KATE WAGNER RD",
            "city": "WESTMINSTER",
            "state": "MD",
            "postal_code": "211576957",
            "telephone_number": "410-848-2500",
            "fax_number": "410-876-3016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "59 KATE WAGNER RD.",
            "city": "WESTMINSTER",
            "state": "MD",
            "postal_code": "21157",
            "telephone_number": "410-848-2500",
            "fax_number": "410-876-3016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARROLL COUNTY YOUTH SERVICE BUREAU, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-27",
        "last_updated": "2023-02-15",
        "certification_date": "2023-02-15",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "LYNN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "443-244-8649",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "MD",
            "license": "12225",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "615501400",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Westminster, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2023; 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.