Provider Demographics
NPI:1346126216
Name:SHEPHERDS PATH MENTAL WELLNESS
Entity type:Organization
Organization Name:SHEPHERDS PATH MENTAL WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BOLANLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:THANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-449-9019
Mailing Address - Street 1:702 TURKANA CIR
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-1266
Mailing Address - Country:US
Mailing Address - Phone:443-449-9019
Mailing Address - Fax:
Practice Address - Street 1:702 TURKANA CIR
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-1266
Practice Address - Country:US
Practice Address - Phone:667-567-0110
Practice Address - Fax:667-280-4044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)