Basic Information
| Provider Information | |||||||||
| NPI: | 1720442684 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BTST SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9701 PHILADELPHIA CT | ||||||||
| Address2: | SUITE R | ||||||||
| City: | LANHAM | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207064400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4439837585 | ||||||||
| FaxNumber: | 4437735624 | ||||||||
| Practice Location | |||||||||
| Address1: | 4303 FORBES BLVD | ||||||||
| Address2: | |||||||||
| City: | LANHAM | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207064333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4439837585 | ||||||||
| FaxNumber: | 4437735624 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2016 | ||||||||
| LastUpdateDate: | 06/04/2020 | ||||||||
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| AuthorizedOfficialLastName: | SIMON | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4439837585 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LGSW | ||||||||
| NPICertificationDate: | 06/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.