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NPI Code Detail

MEDICARE: TIERRA ELLIS

MEDICARE: TIERRA ELLIS
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
1101YM0800XMental Health Counselor230313968MD

General Provider Information

NPI Number : 1487348314
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIERRA ELLIS
Provider Business Mailing Address
First Line : 14900 SWEITZER LN STE 200
Second Line :
City : LAUREL
State : MD
Zip : 20707-2915
Country : US
Telephone Number : 240-360-2161
Fax Number :
Provider Business Practice Location Address
First Line : 14900 SWEITZER LN STE 200
Second Line :
City : LAUREL
State : MD
Zip : 20707-2915
Country : US
Telephone Number : 240-360-2161
Fax Number : 240-360-1938
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2023
Last Update Date : 06/05/2023

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Directions to “ TIERRA ELLIS ” Practice Location

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