Healthcare Provider Details

I. General information

NPI: 1649091745
Provider Name (Legal Business Name): JPP, L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

3881 TEN OAKS RD STE 2A
GLENELG MD
21737-9761
US

IV. Provider business mailing address

5667 COLUMBIA RD APT 202
COLUMBIA MD
21044-1977
US

V. Phone/Fax

Practice location:
  • Phone: 443-520-1005
  • Fax: 410-489-4475
Mailing address:
  • Phone: 443-520-1005
  • Fax: 410-489-4475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES PETER PIFFATH
Title or Position: OWNER
Credential: LCPC
Phone: 443-520-1005