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General NPI Number Information
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NPI Number | 1316146566
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Entity Type | Organization
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Legal Business Name | MARYLAND COUNSELING CENTERS, INC.
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Dates
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Enumeration Date | 07/17/2007
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Last Update Date | 08/14/2015
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Provider Practice Location Address
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Address Line | 5300 WESTVIEW DR. BLDG. 100, SUITE 104
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City | FREDERICK
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State | MD
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Zip | 21703-8327
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Country | US
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Telephone | 310-662-0855
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Fax | 301-662-6261
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Provider Business Mailing Address
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Address Line | 5300 WESTVIEW DR. BLDG. 100, SUITE 104
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City | FREDERICK
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State | MD
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Zip | 21703-9063
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Country | US
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Telephone | 310-662-0855
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Fax | 301-662-6261
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FREDERICK JOHN OELTJEN
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Credential | PH.D.
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Telephone | 301-424-6955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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