Provider Demographics
NPI:1558779207
Name:OUTREACH HEALTH SERVICES BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:OUTREACH HEALTH SERVICES BEHAVIORAL HEALTH LLC
Other - Org Name:OUTREACH BEHAVIORAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE LEGAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-703-1310
Mailing Address - Street 1:251 RENNER PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-1316
Mailing Address - Country:US
Mailing Address - Phone:972-840-7360
Mailing Address - Fax:972-792-6739
Practice Address - Street 1:251 RENNER PKWY
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-1316
Practice Address - Country:US
Practice Address - Phone:972-840-7360
Practice Address - Fax:972-792-6739
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OUTREACH HEALTH CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-25
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX365613401Medicaid