Provider Demographics
NPI:1083120190
Name:LAKES COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:LAKES COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:INTISAR
Authorized Official - Middle Name:O
Authorized Official - Last Name:HUSSEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-412-3318
Mailing Address - Street 1:1600 BROADWAY ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-2617
Mailing Address - Country:US
Mailing Address - Phone:612-412-3318
Mailing Address - Fax:612-288-1805
Practice Address - Street 1:1518 E LAKE ST STE 209
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1849
Practice Address - Country:US
Practice Address - Phone:612-412-3318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-27
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management