Provider Demographics
NPI:1942684402
Name:COMMUNITY OUTREACH RESOURCES, LLC
Entity Type:Organization
Organization Name:COMMUNITY OUTREACH RESOURCES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KIRK
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS LPCC
Authorized Official - Phone:575-390-2529
Mailing Address - Street 1:1601 N TURNER ST
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-4331
Mailing Address - Country:US
Mailing Address - Phone:575-390-2529
Mailing Address - Fax:
Practice Address - Street 1:1601 N TURNER ST
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-4331
Practice Address - Country:US
Practice Address - Phone:575-390-2529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1192101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty