| Lookout Behavioral Health Llc | |
|
7905 N Meadowlark Way Ste A Coeur D Alene ID 83815-5041 | |
| (208) 704-2502 | |
| Not Available |
| Full Name | Lookout Behavioral Health Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 7905 N Meadowlark Way Ste A, Coeur D Alene, Idaho |
| Authorized Official Name and Position | Graham Christensen (OWNER) |
| Authorized Official Contact | 2087040380 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lookout Behavioral Health Llc Po Box 2792 Hayden ID 83835-2792 Ph: (208) 704-0380 | Lookout Behavioral Health Llc 7905 N Meadowlark Way Ste A Coeur D Alene ID 83815-5041 Ph: (208) 704-2502 |
| NPI Number | 1700394822 |
|---|---|
| Provider Enumeration Date | 01/11/2018 |
| Last Update Date | 01/11/2018 |
| Medicare PECOS PAC ID | 9830453752 |
|---|---|
| Medicare Enrollment ID | O20180501001021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700394822 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Mallory I Nehlich |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285986703 PECOS PAC ID: 6608006606 Enrollment ID: I20140312001208 |
| Provider Name | Angela M Munson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649521162 PECOS PAC ID: 7214154434 Enrollment ID: I20140812002442 |
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