Provider Demographics
NPI:1093238461
Name:OUTLOOK CCS, LLC
Entity Type:Organization
Organization Name:OUTLOOK CCS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMOINE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-590-2728
Mailing Address - Street 1:25 OCEAN GREENS DR
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-2166
Mailing Address - Country:US
Mailing Address - Phone:207-590-2728
Mailing Address - Fax:
Practice Address - Street 1:74 BEACH ST
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-2812
Practice Address - Country:US
Practice Address - Phone:207-590-2728
Practice Address - Fax:207-835-4670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-18
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC4689261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health