Healthcare Provider Details

I. General information

NPI: 1477160034
Provider Name (Legal Business Name): CHOLET K JOSUE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14201 LAUREL PARK DR STE 221
LAUREL MD
20707-5203
US

IV. Provider business mailing address

8228 HARVEST BEND LN APT 14
LAUREL MD
20707-6150
US

V. Phone/Fax

Practice location:
  • Phone: 443-885-0915
  • Fax: 443-319-8691
Mailing address:
  • Phone: 312-491-0183
  • Fax: 443-319-8691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. CHOLET KELLY JOSUE
Title or Position: CEO
Credential: MD
Phone: 312-491-0183