Provider Demographics
NPI:1366619389
Name:LIVING OUT LOUD
Entity type:Organization
Organization Name:LIVING OUT LOUD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEACHEM
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:586-945-4488
Mailing Address - Street 1:17301 LIVERNOIS AVE
Mailing Address - Street 2:SUITE 158
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2758
Mailing Address - Country:US
Mailing Address - Phone:586-738-0488
Mailing Address - Fax:586-766-1248
Practice Address - Street 1:22359 SAINT GERTRUDE ST
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-2526
Practice Address - Country:US
Practice Address - Phone:586-945-4488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010884091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty