Provider Demographics
NPI:1255850129
Name:PASSAGEWAYS THERAPY AND COUNSELING, LLC
Entity Type:Organization
Organization Name:PASSAGEWAYS THERAPY AND COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KOEPP
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:301-514-4745
Mailing Address - Street 1:10 N. JEFFERSON STREET
Mailing Address - Street 2:SUITE 403
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21782-1702
Mailing Address - Country:US
Mailing Address - Phone:301-514-4745
Mailing Address - Fax:
Practice Address - Street 1:10 N JEFFERSON ST STE 403
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4823
Practice Address - Country:US
Practice Address - Phone:301-514-4745
Practice Address - Fax:301-668-1854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-12
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD170361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty