Provider Demographics
NPI:1578322293
Name:SUPPORTIVE OUTREACH SERVICES
Entity Type:Organization
Organization Name:SUPPORTIVE OUTREACH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMSW/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VERNELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-226-0621
Mailing Address - Street 1:3333 E BROADWAY AVE STE 1214
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-3395
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3333 E BROADWAY AVE STE 1214
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-3395
Practice Address - Country:US
Practice Address - Phone:701-226-0621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health