Healthcare Provider Details

I. General information

NPI: 1467041764
Provider Name (Legal Business Name): OUTSOURCE 99, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11515 BURNHAM DR # 104F
GIG HARBOR WA
98332-8543
US

IV. Provider business mailing address

PO BOX 1053
GIG HARBOR WA
98335-3053
US

V. Phone/Fax

Practice location:
  • Phone: 253-279-7509
  • Fax: 253-242-9801
Mailing address:
  • Phone: 253-279-7509
  • Fax: 253-242-9801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: JAN LINDHOLM
Title or Position: COUNSELOR
Credential: LMHC, LRCP, MAC, BC-
Phone: 253-279-7509