Provider Demographics
NPI:1760146302
Name:OUTDOOR THERAPEUTICS, LLC
Entity Type:Organization
Organization Name:OUTDOOR THERAPEUTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAJGIER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C, MED
Authorized Official - Phone:301-200-1233
Mailing Address - Street 1:PO BOX 711
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21705
Mailing Address - Country:US
Mailing Address - Phone:301-200-1233
Mailing Address - Fax:866-703-0009
Practice Address - Street 1:12410 MILESTONE CENTER DRIVE
Practice Address - Street 2:STE 600- #652
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876
Practice Address - Country:US
Practice Address - Phone:301-200-1233
Practice Address - Fax:866-703-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty