Provider Demographics
NPI:1073084083
Name:LAKESIDE PROFESSIONAL COUNSELING, P.C.
Entity Type:Organization
Organization Name:LAKESIDE PROFESSIONAL COUNSELING, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:586-932-2700
Mailing Address - Street 1:8072 21 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-4310
Mailing Address - Country:US
Mailing Address - Phone:586-932-2700
Mailing Address - Fax:586-932-2705
Practice Address - Street 1:8072 21 MILE RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48317-4310
Practice Address - Country:US
Practice Address - Phone:586-932-2700
Practice Address - Fax:586-932-2705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2023-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty