Healthcare Provider Details

I. General information

NPI: 1760420152
Provider Name (Legal Business Name): THERAPEUTIC OUTREACH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W MOUNT VERNON ST SUITE 100
SOMERSET KY
42501-1673
US

IV. Provider business mailing address

207 W MOUNT VERNON ST SUITE 100
SOMERSET KY
42501-1673
US

V. Phone/Fax

Practice location:
  • Phone: 606-679-1528
  • Fax: 606-677-0867
Mailing address:
  • Phone: 606-679-1528
  • Fax: 606-677-0867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number991
License Number StateKY

VIII. Authorized Official

Name: MR. CURTIS ALAN DELOACH
Title or Position: PRESIDENT/BOARD CHAIR
Credential: L.C.S.W.
Phone: 606-679-1528