Healthcare Provider Details

I. General information

NPI: 1285579904
Provider Name (Legal Business Name): UNASHAMED OUTREACH GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 OFFICE CLUB PT STE 263
COLORADO SPRINGS CO
80920-5019
US

IV. Provider business mailing address

1880 OFFICE CLUB PT STE 263
COLORADO SPRINGS CO
80920-5019
US

V. Phone/Fax

Practice location:
  • Phone: 214-636-2059
  • Fax:
Mailing address:
  • Phone: 214-636-2059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM RYAN TALBOT
Title or Position: FOUNDER
Credential:
Phone: 214-636-2059