MEDICARE: RAYS OF HOPE MENTAL HEALTH SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0505X	Adult Medicine Physician
2	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1053141325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAYS OF HOPE MENTAL HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	3159 PINE ORCHARD LN APT 302
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-4223
Country	:	US
Telephone Number	:	443-420-8391
Fax Number	:

Provider Business Practice Location Address
First Line	:	3159 PINE ORCHARD LN APT 302
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-4223
Country	:	US
Telephone Number	:	443-420-8391
Fax Number	:	443-240-6123

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEPHANIE RAE GILLIS
Credential	:	CRNP
Telephone Number	:	443-420-8391

Provider Enumeration Date	:	08/02/2024
Last Update Date	:	08/02/2024

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