Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Mental Health (Including Community Mental Health Center) |
261QM0801X | B4[14] | Community Mental Health Center | |
Addiction (Substance Use Disorder) |
101YA0400X | |||
Mental Health |
101YM0800X | |||
Multi-Specialty |
261QM1300X | 70 | Clinic or Group Practice |
| NPI Number | 1407998719 |
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| LBN Legal business name | LAKESIDE FAMILY THERAPY SERVICES LTD | ||||
| Authorized official | JACQUELINE MCRAE - (PRESIDENT) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 02/13/2007 | ||||
| Last updated | 08/06/2021 - About 5 years ago | ||||
| Identifiers |
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