Provider Demographics
NPI:1205653391
Name:OUTBLOOM THERAPY SERVICES LLC
Entity type:Organization
Organization Name:OUTBLOOM THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICKA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOBE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LSCSW, LCSW
Authorized Official - Phone:405-296-3813
Mailing Address - Street 1:9905 S PENNSYLVANIA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-6920
Mailing Address - Country:US
Mailing Address - Phone:405-296-3813
Mailing Address - Fax:
Practice Address - Street 1:10100 W MAPLE ST STE 102
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-3148
Practice Address - Country:US
Practice Address - Phone:316-295-3495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty