Provider Demographics
NPI:1366869232
Name:LOOKOUT, STACY MICHELLE (LPC, PMH-C)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:MICHELLE
Last Name:LOOKOUT
Suffix:
Gender:F
Credentials:LPC, PMH-C
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:MICHELLE
Other - Last Name:KIRK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6706 E 136TH ST N
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74021-5774
Mailing Address - Country:US
Mailing Address - Phone:918-949-0027
Mailing Address - Fax:
Practice Address - Street 1:6706 E 136TH ST N
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:OK
Practice Address - Zip Code:74021-5774
Practice Address - Country:US
Practice Address - Phone:918-949-0027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OK6702101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health