Provider Demographics
NPI:1275037046
Name:POSITIVE OUTCOMES
Entity Type:Organization
Organization Name:POSITIVE OUTCOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:318-396-5210
Mailing Address - Street 1:3602 CYPRESS ST STE D
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-7314
Mailing Address - Country:US
Mailing Address - Phone:318-396-5210
Mailing Address - Fax:318-654-4248
Practice Address - Street 1:3602 CYPRESS ST STE D
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7314
Practice Address - Country:US
Practice Address - Phone:318-396-5210
Practice Address - Fax:318-654-4248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA056103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty