NPIMap

Organization Active NPI

Makonnen Therapeutic Services

  • Professional Counselor
  • Gaithersburg, MD
National Provider Identifier
1558893586
Registry record updated Mar 29, 2017
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Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LC7426 Issued in MD
Legal business name
MAKONNEN THERAPEUTIC SERVICES
Practice address
881 Flagler Dr
Gaithersburg, MD 20878-1968
Phone
(410) 422-3386
NPI assigned
Mar 29, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Raejon Lynne Makonnen
Title
Owner
Phone
(410) 422-3386

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X LC7426 MD Primary

Addresses

Primary practice location

881 Flagler Dr
Gaithersburg, MD 20878-1968

Mailing address

881 Flagler Dr
Gaithersburg, MD 20878-1968
Phone (410) 422-3386

Other identifiers 1

IdentifierTypeStateIssuer
1143824MedicaidMD

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490745600000",
    "number": "1558893586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "881 FLAGLER DR",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208781968",
            "telephone_number": "410-422-3386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "881 FLAGLER DR",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208781968",
            "telephone_number": "410-422-3386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAKONNEN THERAPEUTIC SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-29",
        "last_updated": "2017-03-29",
        "status": "A",
        "authorized_official_last_name": "MAKONNEN",
        "authorized_official_first_name": "RAEJON",
        "authorized_official_middle_name": "LYNNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-422-3386",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "MD",
            "license": "LC7426",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1143824",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gaithersburg, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.