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Organization
OUTBOUND THERAPY LLC
Active
Organization
OUTBOUND THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBALIE COMMISSIONG LCSW (OWNER)
(954) 687-1288
Entity
Organization
Contact information
Practice address
7154 N UNIVERSITY DR, SUITE 164, TAMARAC, FL 33321-2916
(965) 687-1288
(754) 203-0224
Mailing address
7154 N UNIVERSITY DR, SUITE 164, TAMARAC, FL 33321-2916
(965) 687-1288
(754) 203-0224
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW7375
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
767061300
—
FL
Enumeration date
05/05/2015
Last updated
05/05/2015
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