Provider Demographics
NPI:1558547836
Name:ALTERNATIVE OUTLOOK, LLC
Entity Type:Organization
Organization Name:ALTERNATIVE OUTLOOK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-946-2977
Mailing Address - Street 1:PO BOX 1251
Mailing Address - Street 2:
Mailing Address - City:HINDMAN
Mailing Address - State:KY
Mailing Address - Zip Code:41822-1251
Mailing Address - Country:US
Mailing Address - Phone:606-946-2977
Mailing Address - Fax:606-946-2925
Practice Address - Street 1:6905 HWY 550 EAST
Practice Address - Street 2:
Practice Address - City:HINDMAN
Practice Address - State:KY
Practice Address - Zip Code:41822
Practice Address - Country:US
Practice Address - Phone:606-946-2977
Practice Address - Fax:606-946-2925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health