Provider Demographics
NPI:1932457843
Name:LOOKOUT, SAMMY CLARENCE
Entity Type:Individual
Prefix:MR
First Name:SAMMY
Middle Name:CLARENCE
Last Name:LOOKOUT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PAWHUSKA
Mailing Address - State:OK
Mailing Address - Zip Code:74056-3023
Mailing Address - Country:US
Mailing Address - Phone:918-287-5417
Mailing Address - Fax:918-287-3721
Practice Address - Street 1:1011 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:PAWHUSKA
Practice Address - State:OK
Practice Address - Zip Code:74056-3023
Practice Address - Country:US
Practice Address - Phone:918-287-5417
Practice Address - Fax:918-287-3721
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility