Healthcare Provider Details

I. General information

NPI: 1407488612
Provider Name (Legal Business Name): JLU BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 02/20/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18213 HILLCREST AVE
OLNEY MD
20832-1422
US

IV. Provider business mailing address

9123 RT. 108 OLD ANNAPOLIS RD STE 310
COLUMBIA MD
21045
US

V. Phone/Fax

Practice location:
  • Phone: 301-417-5979
  • Fax:
Mailing address:
  • Phone: 443-232-2095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. JANICE L ULRICH
Title or Position: MENTAL HEALTH COUNSELOR
Credential: LCPC
Phone: 443-232-2095