Provider Demographics
NPI:1821386855
Name:OUTREACH PSYCHIATRIC ASSOCIATES, LLC
Entity Type:Organization
Organization Name:OUTREACH PSYCHIATRIC ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZZARI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, BC
Authorized Official - Phone:770-265-2772
Mailing Address - Street 1:250 CONSTITUTION BLVD
Mailing Address - Street 2:STE 203
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-8432
Mailing Address - Country:US
Mailing Address - Phone:770-265-2772
Mailing Address - Fax:866-876-7892
Practice Address - Street 1:250 CONSTITUTION BLVD
Practice Address - Street 2:STE 203
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8432
Practice Address - Country:US
Practice Address - Phone:770-265-2772
Practice Address - Fax:866-876-7892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty