| Eelssen International, Llc | |
|
4200 Forbes Blvd Ste 202 Lanham MD 20706-4829 | |
| (410) 361-0658 | |
| (410) 647-7931 |
| Full Name | Eelssen International, Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 4200 Forbes Blvd Ste 202, Lanham, Maryland |
| Authorized Official Name and Position | James M. Ballard, Iii (OWNER PSYCHOLOGIST) |
| Authorized Official Contact | 4103610658 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Eelssen International, Llc Po Box 281 Odenton MD 21113-0281 Ph: (410) 361-0658 | Eelssen International, Llc 4200 Forbes Blvd Ste 202 Lanham MD 20706-4829 Ph: (410) 361-0658 |
| NPI Number | 1538367669 |
|---|---|
| Provider Enumeration Date | 07/10/2007 |
| Last Update Date | 07/10/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538367669 | NPI | - | NPPES |
| 7308914 | Other | AETNA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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