Provider Demographics
NPI:1669650073
Name:OUTLOOK FORENSIC & BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:OUTLOOK FORENSIC & BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STOUDMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-841-3886
Mailing Address - Street 1:2427 PLANTATION CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-6204
Mailing Address - Country:US
Mailing Address - Phone:704-841-3886
Mailing Address - Fax:704-841-3889
Practice Address - Street 1:2427 PLANTATION CENTER DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-6204
Practice Address - Country:US
Practice Address - Phone:704-841-3886
Practice Address - Fax:704-841-3889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty