MEDICARE: PRECIOUS OTU ITA

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	:	1538927868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRECIOUS OTU ITA

Provider Business Mailing Address
First Line	:	7698 BELAIR RD STE C1
Second Line	:
City	:	NOTTINGHAM
State	:	MD
Zip	:	21236-4066
Country	:	US
Telephone Number	:	410-558-7798
Fax Number	:

Provider Business Practice Location Address
First Line	:	7698 BELAIR RD STE C1
Second Line	:
City	:	NOTTINGHAM
State	:	MD
Zip	:	21236-4066
Country	:	US
Telephone Number	:	410-558-7798
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2024
Last Update Date	:	02/12/2026

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Directions to “ PRECIOUS OTU ITA ” Practice Location

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