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NPI Code Detail

MEDICARE: MARIAH TAMIA BOURGOUIS

MEDICARE: MARIAH TAMIA BOURGOUIS
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1548092349
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIAH TAMIA BOURGOUIS
Provider Business Mailing Address
First Line : 8818 CENTRE PARK DR
Second Line :
City : COLUMBIA
State : MD
Zip : 21045-2159
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8818 CENTRE PARK DR
Second Line :
City : COLUMBIA
State : MD
Zip : 21045-2159
Country : US
Telephone Number : 301-265-5617
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2024
Last Update Date : 08/19/2024

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Directions to “ MARIAH TAMIA BOURGOUIS ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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