Lakeside Family Therapy Services Ltd

LBN: Lakeside Family Therapy Services Ltd
Lakeside Family Therapy Services Ltd is an health care organization with primary practice located at 4810 Northwestern Ave , Racine WI 53406. The organization recently has 4 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Health, Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center), Ambulatory Health Care Facilities / Multi-Specialty. Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center) is the primary health care specialty. Lakeside Family Therapy Services Ltd can be contacted via phone (262) 637-9984, or through Mcrae, Jacqueline V via phone (262) 637-9984.

Contact Information

Primary practice address
4810 Northwestern Ave Racine WI 53406
Phone: (262) 637-9984
Fax: (262) 637-9995
Website:
Map and Directions
Authorized official contact:
Name: Mcrae, Jacqueline V
Phone: (262) 637-9984

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X
Behavioral Health & Social Service Providers / Mental Health 101YM0800X
Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center) 261QM0801X
Ambulatory Health Care Facilities / Multi-Specialty 261QM1300X

Profile Details

NPI number 1407998719
LBN Legal business name Lakeside Family Therapy Services Ltd
DBA Doing business as
Authorized official Mcrae, Jacqueline V
Entity Organization
Organization subpart 1 No
Enumeration date Feb 13th, 2007
Last updated Aug 6th, 2021 - about 4 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407998719 NPPES
Wisconsin MEDICAID 42120700

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