MEDICARE: MS. JILL B CODY M.A.

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	101YM0800X	Mental Health Counselor	0029	MD

General Provider Information

NPI Number	:	1073772786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JILL B CODY M.A.

Provider Business Mailing Address
First Line	:	186 THOMAS JOHNSON DR
Second Line	:	SUITE 200
City	:	FREDERICK
State	:	MD
Zip	:	21702-4305
Country	:	US
Telephone Number	:	301-662-2266
Fax Number	:	301-662-4448

Provider Business Practice Location Address
First Line	:	186 THOMAS JOHNSON DR
Second Line	:	SUITE 200
City	:	FREDERICK
State	:	MD
Zip	:	21702-4305
Country	:	US
Telephone Number	:	301-662-2266
Fax Number	:	301-662-4448

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2008
Last Update Date	:	06/06/2008

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