Provider Demographics
NPI:1003159278
Name:NESLEN, JARED PORTER (MED)
Entity Type:Individual
Prefix:MR
First Name:JARED
Middle Name:PORTER
Last Name:NESLEN
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 THOMAS JOHNSON DR
Mailing Address - Street 2:STE 200
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4402
Mailing Address - Country:US
Mailing Address - Phone:301-708-1860
Mailing Address - Fax:
Practice Address - Street 1:172 THOMAS JOHNSON DR
Practice Address - Street 2:STE 200
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4402
Practice Address - Country:US
Practice Address - Phone:301-694-5896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7433037-6004101YM0800X
MDLC6790101YP2500X
PAPC008632101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health