Provider Demographics
NPI:1205697885
Name:FRESH OUTLOOK, PLLC
Entity type:Organization
Organization Name:FRESH OUTLOOK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRESHOUR
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:404-277-4774
Mailing Address - Street 1:657 MAIN ST NW STE 104
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1578
Mailing Address - Country:US
Mailing Address - Phone:612-439-3084
Mailing Address - Fax:612-500-4796
Practice Address - Street 1:657 MAIN ST NW STE 104
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1578
Practice Address - Country:US
Practice Address - Phone:612-439-3084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-19
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)