Provider Demographics
NPI:1679121529
Name:SOJOURN THERAPY OUTREACH LLC
Entity Type:Organization
Organization Name:SOJOURN THERAPY OUTREACH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNE
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BYNDOM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:314-399-4823
Mailing Address - Street 1:9666 OLIVE BLVD STE 330
Mailing Address - Street 2:
Mailing Address - City:OLIVETTE
Mailing Address - State:MO
Mailing Address - Zip Code:63132-3035
Mailing Address - Country:US
Mailing Address - Phone:314-399-4823
Mailing Address - Fax:
Practice Address - Street 1:9666 OLIVE BLVD STE 330
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-3035
Practice Address - Country:US
Practice Address - Phone:314-399-4823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-03
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty