The Outreach Foundation, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

1630 Issued in VA

Legal business name

THE OUTREACH FOUNDATION, LLC

Practice address

20 E Tabb St
Suite 201
Petersburg, VA 23803-4541

Phone

(888) 800-0040

Fax

(888) 800-0040

NPI assigned

Aug 26, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jason Moore, BA

Title

Exec Officer

Phone

(888) 800-0040

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1314316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334016000000",
    "number": "1588944151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 E TABB ST",
            "address_2": "SUITE 201",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238034541",
            "telephone_number": "888-800-0040",
            "fax_number": "888-800-0040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 E TABB ST",
            "address_2": "SUITE 201",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238034541",
            "telephone_number": "888-800-0040",
            "fax_number": "888-800-0040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE OUTREACH FOUNDATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-26",
        "last_updated": "2012-04-10",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "EXEC OFFICER",
        "authorized_official_telephone_number": "888-800-0040",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "BA"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "VA",
            "license": "1630",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Petersburg, VA
• Providers in Petersburg, VA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.