# MAGELLAN PROVIDER SERVICES OF CA PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548984404
- **Authorized official:** MR. BRIAN FREY (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (314) 406-8632

## Contact information

- **Practice address:** 8621 ROBERT FULTON DR, COLUMBIA, MD 21046-2620
- **Practice address phone:** (833) 605-0634
- **Mailing address:** 8621 ROBERT FULTON DR, COLUMBIA, MD 21046-2620
- **Mailing address phone:** (833) 605-0634

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |

## Other

- **Enumeration date:** 10/03/2022
- **Last updated:** 10/03/2022