# ANTHEM BEHAVIORAL HEALTH, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417736091
- **Authorized official:** JENNIFER PETRIK (CEO)
- **Authorized official phone:** (443) 567-6091

## Contact information

- **Practice address:** 404 N HICKORY AVE, BEL AIR, MD 21014-3227
- **Practice address phone:** (410) 459-7699
- **Mailing address:** 404 N HICKORY AVE, BEL AIR, MD 21014-3227
- **Mailing address phone:** (443) 567-6091

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 101YP2500X | Professional Counselor | — | NULL | — |
| 101YP2500X | Professional Counselor | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 09/25/2023
- **Last updated:** 02/13/2025