Healthcare Provider Details

I. General information

NPI: 1497683619
Provider Name (Legal Business Name): TAMMILEE PATRA JULES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19200 CROSS RIDGE DR
GERMANTOWN MD
20874-1594
US

IV. Provider business mailing address

19200 CROSS RIDGE DR
GERMANTOWN MD
20874-1594
US

V. Phone/Fax

Practice location:
  • Phone: 240-454-5631
  • Fax:
Mailing address:
  • Phone: 301-968-5971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC17779
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: