Healthcare Provider Details

I. General information

NPI: 1194129494
Provider Name (Legal Business Name): TOTAL YOU INTEGRATIVE MEDICINE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2014
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9135 PISCATAWAY ROAD SUITE 410
CLINTON MD
20735
US

IV. Provider business mailing address

PO BOX 1786
CLINTON MD
20735-5786
US

V. Phone/Fax

Practice location:
  • Phone: 240-348-7860
  • Fax: 240-348-7861
Mailing address:
  • Phone: 240-383-4800
  • Fax: 240-846-1533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number659918
License Number StateMD

VIII. Authorized Official

Name: DR. JOHN-PAUL JAMES
Title or Position: BIOMEDICAL NEUROSCIENTIST
Credential: PH.D., D.MIN., DACBN
Phone: 240-383-4800