Provider Demographics
NPI:1780055251
Name:OPTIMISTIC OUTCOMES, PLLC
Entity type:Organization
Organization Name:OPTIMISTIC OUTCOMES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERONDA
Authorized Official - Middle Name:RAQUEL
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-346-7256
Mailing Address - Street 1:PO BOX 252512
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48325-2512
Mailing Address - Country:US
Mailing Address - Phone:248-346-7256
Mailing Address - Fax:
Practice Address - Street 1:17340 W 12 MILE RD
Practice Address - Street 2:SUITE #204
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2122
Practice Address - Country:US
Practice Address - Phone:248-346-7256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty