MEDICARE: JMT CONSULTING

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	261QM0850X	Adult Mental Health Clinic/Center
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1699285114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JMT CONSULTING

Provider Business Mailing Address
First Line	:	15808 JEFFERSON DAVIS HWY
Second Line	:
City	:	SOUTH CHESTERFIELD
State	:	VA
Zip	:	23834-5202
Country	:	US
Telephone Number	:	804-629-2673
Fax Number	:

Provider Business Practice Location Address
First Line	:	15808 JEFFERSON DAVIS HWY
Second Line	:
City	:	SOUTH CHESTERFIELD
State	:	VA
Zip	:	23834-5202
Country	:	US
Telephone Number	:	804-629-2673
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JASMARY TINEO
Credential	:	QPPMH
Telephone Number	:	804-629-2673

Provider Enumeration Date	:	10/10/2017
Last Update Date	:	10/10/2017

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