Provider Demographics
NPI:1700873676
Name:OUTREACH THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:OUTREACH THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOGIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHAUNDRA
Authorized Official - Middle Name:ELOIS
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:404-277-9869
Mailing Address - Street 1:1307 ADAMS LAKE BLVD SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3387
Mailing Address - Country:US
Mailing Address - Phone:404-277-9869
Mailing Address - Fax:
Practice Address - Street 1:1307 ADAMS LAKE BLVD SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3387
Practice Address - Country:US
Practice Address - Phone:404-277-9869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005643235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty