Provider Demographics
NPI:1710794680
Name:OPHIUCHUS COUNSELING AND PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:OPHIUCHUS COUNSELING AND PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEWMAW
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:410-357-1315
Mailing Address - Street 1:758 MAGO VISTA RD
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-1139
Mailing Address - Country:US
Mailing Address - Phone:410-357-1301
Mailing Address - Fax:
Practice Address - Street 1:1511 GOVENRNOR RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2465
Practice Address - Country:US
Practice Address - Phone:410-357-1301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-14
Last Update Date:2024-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)