Provider Demographics
NPI:1083814925
Name:KREH, JAN (MS)
Entity Type:Individual
Prefix:MRS
First Name:JAN
Middle Name:
Last Name:KREH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 N RIDGE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3383
Mailing Address - Country:US
Mailing Address - Phone:410-750-3330
Mailing Address - Fax:410-750-3332
Practice Address - Street 1:3300 N RIDGE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3383
Practice Address - Country:US
Practice Address - Phone:410-750-3330
Practice Address - Fax:410-750-3332
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1527101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional