Provider Demographics
NPI:1144751918
Name:BE YOU OUTREACH CENTER
Entity Type:Organization
Organization Name:BE YOU OUTREACH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:W
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-626-5626
Mailing Address - Street 1:7505 PINES ROAD
Mailing Address - Street 2:SUITE 1295
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129
Mailing Address - Country:US
Mailing Address - Phone:318-626-5626
Mailing Address - Fax:318-626-5726
Practice Address - Street 1:7505 PINES RD
Practice Address - Street 2:SUITE 1295
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-3935
Practice Address - Country:US
Practice Address - Phone:318-626-5626
Practice Address - Fax:318-626-5726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA251T00000XMedicaid
LA261QM0801XMedicaid
LA251S00000XMedicaid