Provider Demographics
NPI:1407488612
Name:JLU BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:JLU BEHAVIORAL HEALTH SERVICES
Other - Org Name:JLU BEHAVIORAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ULRICH
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:443-232-2095
Mailing Address - Street 1:9123 RT. 108 OLD ANNAPOLIS RD
Mailing Address - Street 2:STE 310
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045
Mailing Address - Country:US
Mailing Address - Phone:443-232-2095
Mailing Address - Fax:
Practice Address - Street 1:18213 HILLCREST AVE
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1422
Practice Address - Country:US
Practice Address - Phone:301-417-5979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-05
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1922402619Medicaid