Provider Demographics
NPI:1134893985
Name:JUSPEN BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:JUSPEN BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-704-1973
Mailing Address - Street 1:4710 AUTH PLACE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:CAMP SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20746-1373
Mailing Address - Country:US
Mailing Address - Phone:301-704-1973
Mailing Address - Fax:
Practice Address - Street 1:4710 AUTH PLACE
Practice Address - Street 2:SUITE 410
Practice Address - City:CAMP SPRING
Practice Address - State:MD
Practice Address - Zip Code:20746-1373
Practice Address - Country:US
Practice Address - Phone:301-704-1973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JUSPEN BEHAVIORAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty