Organization
MAGELLAN PROVIDER SERVICES OF CA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN FREY (CHIEF FINANCIAL OFFICER)
(314) 406-8632
Entity
Organization
Contact information
Practice address
8621 ROBERT FULTON DR, COLUMBIA, MD 21046-2620
(833) 605-0634
Mailing address
8621 ROBERT FULTON DR, COLUMBIA, MD 21046-2620
(833) 605-0634
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
10/03/2022
Last updated
10/03/2022
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