Provider Demographics
NPI:1881894525
Name:ESSENTIAL THERAPEUTIC PERSPECTIVES, INC
Entity type:Organization
Organization Name:ESSENTIAL THERAPEUTIC PERSPECTIVES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:JACQUET
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWC
Authorized Official - Phone:301-577-4440
Mailing Address - Street 1:8240 PROFESSIONAL PL STE 200
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2215
Mailing Address - Country:US
Mailing Address - Phone:301-577-4440
Mailing Address - Fax:301-577-4123
Practice Address - Street 1:8240 PROFESSIONAL PL STE 200
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-2215
Practice Address - Country:US
Practice Address - Phone:301-577-4440
Practice Address - Fax:301-577-4123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404683800Medicaid