Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 7433037-6004 | UT |
Y | 101YP2500X | Professional Counselor | LC6790 | MD |
N | 101YP2500X | Professional Counselor | PC008632 | PA |
NPI | 1003159278 |
---|---|
Provider Name | Mr. Jared Porter Neslen |
First Address | Frederick, MD 21702-4402 |
Second Address | Frederick, MD 21702-4402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2013 |
Last Update Date | 23/05/2016 |