Provider Demographics
NPI:1487915427
Name:SUNFLOWER BEHAVIORAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:SUNFLOWER BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MALINDA
Authorized Official - Middle Name:DIANN
Authorized Official - Last Name:ROYSTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:301-638-7181
Mailing Address - Street 1:3195 OLD WASHINGTON RD
Mailing Address - Street 2:SUITE 227
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3201
Mailing Address - Country:US
Mailing Address - Phone:301-638-7181
Mailing Address - Fax:301-638-7182
Practice Address - Street 1:3195 OLD WASHINGTON RD
Practice Address - Street 2:227
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3201
Practice Address - Country:US
Practice Address - Phone:301-638-7181
Practice Address - Fax:301-638-7182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD125101041C0700X
MDLC0773101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD620400700Medicaid
MD678917OtherMARYLANDVALUEOPTIONS