Provider Demographics
NPI:1982331781
Name:OUTLAW, THELMA MONIQUE
Entity Type:Individual
Prefix:
First Name:THELMA
Middle Name:MONIQUE
Last Name:OUTLAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 BREWSTER DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-6022
Mailing Address - Country:US
Mailing Address - Phone:845-800-2152
Mailing Address - Fax:
Practice Address - Street 1:75 BREWSTER DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-6022
Practice Address - Country:US
Practice Address - Phone:845-800-2152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health