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General NPI Number Information
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NPI Number | 1366869232
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Entity Type | Individual
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Provider Name | STACY MICHELLE LOOKOUT LPC, PMH-C
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Gender | Female
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Dates
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Enumeration Date | 03/27/2014
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 6706 E 136TH ST N
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City | COLLINSVILLE
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State | OK
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Zip | 74021-5774
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Country | US
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Telephone | 918-949-0027
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Fax |
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Provider Business Mailing Address
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Address Line | 6706 E 136TH ST N
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City | COLLINSVILLE
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State | OK
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Zip | 74021-5774
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Country | US
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Telephone | 918-949-0027
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6702
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License Number State | OK
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