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Organization
OUTLOOK FORENSIC AND BEHAVIORAL HEALTH
Active
Organization
OUTLOOK FORENSIC AND BEHAVIORAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN KEITH STOUDMIRE M.D. (PRESIDENT)
(704) 699-5296
Entity
Organization
Contact information
Practice address
1254 MANN DR, SUITE 100, MATTHEWS, NC 28105-5545
(704) 841-3886
(704) 841-3889
Mailing address
1254 MANN DR, SUITE 100, MATTHEWS, NC 28105-5545
(704) 841-3886
(704) 841-3889
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
200500827
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5900927
—
NC
Enumeration date
08/02/2013
Last updated
08/05/2013
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