Healthcare Provider Details

I. General information

NPI: 1881226413
Provider Name (Legal Business Name): LOOKOUT BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7905 N MEADOWLARK WAY STE A
COEUR D ALENE ID
83815-5041
US

IV. Provider business mailing address

PO BOX 2792
HAYDEN ID
83835-2792
US

V. Phone/Fax

Practice location:
  • Phone: 208-762-2500
  • Fax:
Mailing address:
  • Phone: 208-762-9856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: GRAHAM M CHRISTENSEN
Title or Position: MEMBER
Credential:
Phone: 208-704-0380