Provider Demographics
NPI:1639605900
Name:TAYJARI COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:TAYJARI COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNEIL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-996-4269
Mailing Address - Street 1:2500 N ROLLING RD STE 201
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2010
Mailing Address - Country:US
Mailing Address - Phone:443-996-4269
Mailing Address - Fax:443-348-7597
Practice Address - Street 1:2500 N ROLLING RD STE 201
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-2010
Practice Address - Country:US
Practice Address - Phone:443-996-4269
Practice Address - Fax:443-348-7597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-05
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2117251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD681029Medicaid