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General NPI Number Information
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NPI Number | 1467041764
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Entity Type | Organization
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Legal Business Name | OUTSOURCE 99, LLC
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Dates
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Enumeration Date | 01/12/2021
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Last Update Date | 01/12/2021
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Provider Practice Location Address
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Address Line | 11515 BURNHAM DR # 104F
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City | GIG HARBOR
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State | WA
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Zip | 98332-8543
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Country | US
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Telephone | 253-279-7509
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Fax | 253-242-9801
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Provider Business Mailing Address
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Address Line | PO BOX 1053
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City | GIG HARBOR
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State | WA
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Zip | 98335-3053
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Country | US
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Telephone | 253-279-7509
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Fax | 253-242-9801
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Authorized Official
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Title or Position | COUNSELOR
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Name | JAN LINDHOLM
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Credential | LMHC, LRCP, MAC, BC-
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Telephone | 253-279-7509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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