Provider Demographics
NPI:1245636430
Name:LAKESIDE COUNSELING
Entity type:Organization
Organization Name:LAKESIDE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:BUFFI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-703-7911
Mailing Address - Street 1:3311 S 4985 W
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-1700
Mailing Address - Country:US
Mailing Address - Phone:801-703-7911
Mailing Address - Fax:
Practice Address - Street 1:2860 W 4700 S # G2
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-2157
Practice Address - Country:US
Practice Address - Phone:801-703-7911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-14
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
UT351724-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty