MEDICARE: JUSPEN BEHAVIORAL HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1134893985
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUSPEN BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	4710 AUTH PLACE
Second Line	:	SUITE 410
City	:	CAMP SPRING
State	:	MD
Zip	:	20746-1373
Country	:	US
Telephone Number	:	301-704-1973
Fax Number	:

Provider Business Practice Location Address
First Line	:	4710 AUTH PLACE
Second Line	:	SUITE 410
City	:	CAMP SPRING
State	:	MD
Zip	:	20746-1373
Country	:	US
Telephone Number	:	301-704-1973
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JUDIE JOHNSON
Credential	:
Telephone Number	:	301-704-1973

Provider Enumeration Date	:	08/05/2021
Last Update Date	:	08/05/2021

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