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9314 Piscataway Rd Ste 250 Clinton MD 20735-3630 | |
| (240) 965-1715 | |
| (240) 965-1716 |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 9314 Piscataway Rd Ste 250, Clinton, Maryland |
| Authorized Official Name and Position | Pamela Saulpaw (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 6028987254 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2701 N 16th St Suite 316 Phoenix AZ 85006-1263 Ph: (602) 650-1212 | 9314 Piscataway Rd Ste 250 Clinton MD 20735-3630 Ph: (240) 965-1715 |
| NPI Number | 1508308180 |
|---|---|
| Provider Enumeration Date | 11/14/2016 |
| Last Update Date | 02/05/2025 |
| Certification Date | 02/05/2025 |
| Medicare PECOS PAC ID | 1456500628 |
|---|---|
| Medicare Enrollment ID | O20240624000457 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508308180 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Courtney Neville Reed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841718624 PECOS PAC ID: 7214295898 Enrollment ID: I20180103002976 |
| Provider Name | Tracee Burroughs |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992834238 PECOS PAC ID: 8224197090 Enrollment ID: I20190109000612 |
| Provider Name | Telisa J Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609530807 PECOS PAC ID: 8628469723 Enrollment ID: I20241209003991 |
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