Provider Demographics
NPI:1932946837
Name:PIVOTAL MOMENTS OUTREACH INC
Entity type:Organization
Organization Name:PIVOTAL MOMENTS OUTREACH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SCHOLAR
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-308-4574
Mailing Address - Street 1:166 NEWBURY LN
Mailing Address - Street 2:
Mailing Address - City:SUNSET
Mailing Address - State:LA
Mailing Address - Zip Code:70584-6144
Mailing Address - Country:US
Mailing Address - Phone:337-308-4574
Mailing Address - Fax:
Practice Address - Street 1:166 NEWBURY LN
Practice Address - Street 2:
Practice Address - City:SUNSET
Practice Address - State:LA
Practice Address - Zip Code:70584-6144
Practice Address - Country:US
Practice Address - Phone:337-308-4574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIVOTAL MOMENTS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty