Provider Demographics
NPI:1467041764
Name:OUTSOURCE 99, LLC
Entity Type:Organization
Organization Name:OUTSOURCE 99, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDHOLM
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, LRCP, MAC, BC-
Authorized Official - Phone:253-279-7509
Mailing Address - Street 1:PO BOX 1053
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-3053
Mailing Address - Country:US
Mailing Address - Phone:253-279-7509
Mailing Address - Fax:253-242-9801
Practice Address - Street 1:11515 BURNHAM DR # 104F
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-8543
Practice Address - Country:US
Practice Address - Phone:253-279-7509
Practice Address - Fax:253-242-9801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty