Healthcare Provider Details

I. General information

NPI: 1316146566
Provider Name (Legal Business Name): MARYLAND COUNSELING CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 WESTVIEW DR. BLDG. 100, SUITE 104
FREDERICK MD
21703-8327
US

IV. Provider business mailing address

5300 WESTVIEW DR. BLDG. 100, SUITE 104
FREDERICK MD
21703-9063
US

V. Phone/Fax

Practice location:
  • Phone: 310-662-0855
  • Fax: 301-662-6261
Mailing address:
  • Phone: 310-662-0855
  • Fax: 301-662-6261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. FREDERICK JOHN OELTJEN
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 301-424-6955