Basic Information
| Provider Information | |||||||||
| NPI: | 1306573761 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BOUNDLESS MENTAL HEALTH | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1215 STOCKPORT CT | ||||||||
| Address2: | |||||||||
| City: | BOWIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207211836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012545618 | ||||||||
| FaxNumber: | 3216167600 | ||||||||
| Practice Location | |||||||||
| Address1: | 1215 STOCKPORT CT | ||||||||
| Address2: | |||||||||
| City: | BOWIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207211836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012545618 | ||||||||
| FaxNumber: | 3216167600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2022 | ||||||||
| LastUpdateDate: | 08/05/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | FOLAWEWO | ||||||||
| AuthorizedOfficialFirstName: | OLATUNJI | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 3012545618 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNP-PMH | ||||||||
| NPICertificationDate: | 08/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.