Provider Demographics
NPI:1548541782
Name:THE OUTLET PLACE FOR WOMEN
Entity type:Organization
Organization Name:THE OUTLET PLACE FOR WOMEN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DETRONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:COULSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-984-4841
Mailing Address - Street 1:3401 BROADWAY ST # 16
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2403
Mailing Address - Country:US
Mailing Address - Phone:816-984-4841
Mailing Address - Fax:
Practice Address - Street 1:1308 W TRUMAN RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64050-3433
Practice Address - Country:US
Practice Address - Phone:816-984-4841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty