Healthcare Provider Details

I. General information

NPI: 1306297460
Provider Name (Legal Business Name): OUTREACH HOUSING AND COMMUNITY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 NORTH CLEVELAND
MEMPHIS TN
38104-2002
US

IV. Provider business mailing address

135 NORTH CLEVELAND
MEMPHIS TN
38104-2002
US

V. Phone/Fax

Practice location:
  • Phone: 800-274-1843
  • Fax: 800-274-1843
Mailing address:
  • Phone: 800-274-1843
  • Fax: 800-274-1843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberL000000017975
License Number StateTN

VIII. Authorized Official

Name: SHALONDA NAKIA ADAMS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 800-274-1843