Provider Demographics
NPI:1689418741
Name:OUR PLACE, LLC
Entity type:Organization
Organization Name:OUR PLACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERCEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:443-819-0143
Mailing Address - Street 1:4990 MERCANTILE RD UNIT 44723
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-8572
Mailing Address - Country:US
Mailing Address - Phone:443-819-0143
Mailing Address - Fax:
Practice Address - Street 1:4990 MERCANTILE RD UNIT 44723
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-8572
Practice Address - Country:US
Practice Address - Phone:443-819-0143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD907666200Medicaid