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Contact Information

LAKESIDE FAMILY THERAPY SERVICES LTD
4810 NORTHWESTERN AVE
RACINE, WI53406
 Phone: 262-637-9984
 Fax: 262-637-9995
 Website:
 

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
Indicates primary specialty

NPI Profile & details for LAKESIDE FAMILY THERAPY SERVICES LTD

NPI Number 1407998719
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
WI Medicaid 42120700
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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