MEDICARE: UNLEASHING POTENTIAL 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1902378680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNLEASHING POTENTIAL LLC

Provider Business Mailing Address
First Line	:	11100 LIBERTY RD STE G
Second Line	:
City	:	RANDALLSTOWN
State	:	MD
Zip	:	21133-1054
Country	:	US
Telephone Number	:	410-419-8738
Fax Number	:

Provider Business Practice Location Address
First Line	:	11100 LIBERTY RD STE G
Second Line	:
City	:	RANDALLSTOWN
State	:	MD
Zip	:	21133-1054
Country	:	US
Telephone Number	:	443-831-7989
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	TARIN LIGENS
Credential	:
Telephone Number	:	410-419-8738

Provider Enumeration Date	:	12/19/2018
Last Update Date	:	06/03/2024

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