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General NPI Number Information
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NPI Number | 1003279282
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Entity Type | Organization
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Legal Business Name | LOOKOUT MANAGMENT LLC
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Dates
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Enumeration Date | 04/04/2016
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Last Update Date | 04/04/2016
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Provider Practice Location Address
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Address Line | 6901 LOOKOUT RD
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City | BOULDER
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State | CO
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Zip | 80301-3529
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Country | US
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Telephone | 303-443-7695
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Fax |
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Provider Business Mailing Address
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Address Line | 6901 LOOKOUT RD
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City | BOULDER
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State | CO
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Zip | 80301-3529
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Country | US
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Telephone | 303-443-7695
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Fax |
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Authorized Official
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Title or Position | CLINICAL OPERATIONS DIRECTOR
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Name | DOREE NEWBERY
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Credential | MS, CAC III, MAC
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Telephone | 303-443-7695
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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