1699771212 NPI number — OUTREACH 12

Table of content: (NPI 1699771212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699771212 NPI number — OUTREACH 12

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OUTREACH 12
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OUTREACH 12 COUNSELING CENTERS OF TEXAS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699771212
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 147
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENCINO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78353-0147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-325-4921
Provider Business Mailing Address Fax Number:
361-325-5768

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2208 PRIMROSE AVE
Provider Second Line Business Practice Location Address:
STE H-A
Provider Business Practice Location Address City Name:
MCALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78504-4155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-682-6889
Provider Business Practice Location Address Fax Number:
956-682-6889
Provider Enumeration Date:
06/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WEBSTER-NEAL
Authorized Official First Name:
JACKIE
Authorized Official Middle Name:
SUSAN
Authorized Official Title or Position:
PROGRAM DIRECTOR
Authorized Official Telephone Number:
361-568-3761

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , with the licence number:  1918-A , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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