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General NPI Number Information
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NPI Number | 1669918199
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Entity Type | Organization
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Legal Business Name | STREET OUTREACH SOLUTIONS,LLC
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Dates
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Enumeration Date | 01/08/2017
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Last Update Date | 06/23/2023
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Provider Practice Location Address
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Address Line | 2715 MACKEY PL STE 119
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City | SHREVEPORT
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State | LA
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Zip | 71118-2527
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Country | US
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Telephone | 318-393-5407
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Fax |
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Provider Business Mailing Address
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Address Line | 2715 MACKEY PL STE 119
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City | SHREVEPORT
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State | LA
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Zip | 71118-2527
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Country | US
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Telephone | 318-771-7707
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MRS. MAR'DOSHA PEEK
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Credential |
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Telephone | 318-771-7707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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