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NPI Code Detail

MEDICARE: JILLIAN OUT MA

MEDICARE: JILLIAN OUT MA
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
1101Y00000XCounselorA0526MD

General Provider Information

NPI Number : 1265968895
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILLIAN OUT MA
Provider Business Mailing Address
First Line : 5248 CEDAR LN APT 152
Second Line :
City : COLUMBIA
State : MD
Zip : 21044-1498
Country : US
Telephone Number : 734-778-2410
Fax Number :
Provider Business Practice Location Address
First Line : 15817 CRABBS BRANCH WAY
Second Line :
City : ROCKVILLE
State : MD
Zip : 20855-6613
Country : US
Telephone Number : 301-948-2280
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2017
Last Update Date : 02/24/2022

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Directions to “ JILLIAN OUT MA” Practice Location

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