Provider Demographics
NPI:1346451382
Name:LAKELAND COUNSELING ASSOCIATES, LLC
Entity Type:Organization
Organization Name:LAKELAND COUNSELING ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:L
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:601-981-5678
Mailing Address - Street 1:1640 LELIA DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4832
Mailing Address - Country:US
Mailing Address - Phone:601-981-5678
Mailing Address - Fax:601-981-5996
Practice Address - Street 1:1640 LELIA DR
Practice Address - Street 2:SUITE 140
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4832
Practice Address - Country:US
Practice Address - Phone:601-981-5678
Practice Address - Fax:601-981-5996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS779101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty