Provider Demographics
NPI:1508338575
Name:OUTSIDE REIN, LLC
Entity Type:Organization
Organization Name:OUTSIDE REIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:JULIA
Authorized Official - Last Name:EKKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LAC
Authorized Official - Phone:719-235-7473
Mailing Address - Street 1:13576 COUNTY RD 1
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:CO
Mailing Address - Zip Code:80816-9001
Mailing Address - Country:US
Mailing Address - Phone:719-235-7473
Mailing Address - Fax:719-748-0196
Practice Address - Street 1:13576 COUNTY RD 1
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:CO
Practice Address - Zip Code:80816-9001
Practice Address - Country:US
Practice Address - Phone:719-235-7473
Practice Address - Fax:719-748-0196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-31
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty