1831470863 NPI number — PSYCHOTHERAPY & COUNSELING SERVICE

Table of content: (NPI 1831470863)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831470863 NPI number — PSYCHOTHERAPY & COUNSELING SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PSYCHOTHERAPY & COUNSELING SERVICE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831470863
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5620 MIRRORLIGHT PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21045-3214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-419-1708
Provider Business Mailing Address Fax Number:
410-312-7298

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10632 LITTLE PATUXENT PKWY
Provider Second Line Business Practice Location Address:
SUITE 245
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21044-3273
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-312-7250
Provider Business Practice Location Address Fax Number:
410-312-7298
Provider Enumeration Date:
09/04/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PASTOR
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
410-312-7250

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  11610 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 585S . This is a "MEDICARE ID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 819906526 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 528219 . This is a "VALUE OPTIONS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: X8120001 . This is a "CAREFIRST BLUECHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2113960 . This is a "MAMSI/OPTIMUM CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: C9HJ . This is a "CAREFIRST MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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