Provider Demographics
NPI:1104698695
Name:IN HIS IMAGE OUTREACH
Entity type:Organization
Organization Name:IN HIS IMAGE OUTREACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:864-381-5248
Mailing Address - Street 1:PO BOX 413
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:SC
Mailing Address - Zip Code:29627-0413
Mailing Address - Country:US
Mailing Address - Phone:864-381-5248
Mailing Address - Fax:
Practice Address - Street 1:1100 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29624-2012
Practice Address - Country:US
Practice Address - Phone:864-381-5248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty