MEDICARE: PIVOTAL MOMENTS OUTREACH INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist

General Provider Information

NPI Number	:	1932946837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIVOTAL MOMENTS OUTREACH INC

Provider Business Mailing Address
First Line	:	166 NEWBURY LN
Second Line	:
City	:	SUNSET
State	:	LA
Zip	:	70584-6144
Country	:	US
Telephone Number	:	337-308-4574
Fax Number	:

Provider Business Practice Location Address
First Line	:	166 NEWBURY LN
Second Line	:
City	:	SUNSET
State	:	LA
Zip	:	70584-6144
Country	:	US
Telephone Number	:	337-308-4574
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. SCHOLAR JENKINS
Credential	:
Telephone Number	:	337-308-4574

Provider Enumeration Date	:	07/09/2024
Last Update Date	:	07/09/2024

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