Provider Demographics
NPI:1376086314
Name:THREE LAKES COUNSELING LLC
Entity Type:Organization
Organization Name:THREE LAKES COUNSELING LLC
Other - Org Name:WESTSIDE MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LMHC
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:317-672-6400
Mailing Address - Street 1:192 N AVON AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-9513
Mailing Address - Country:US
Mailing Address - Phone:317-672-6400
Mailing Address - Fax:317-672-6401
Practice Address - Street 1:192 N AVON AVE
Practice Address - Street 2:STE 300
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9513
Practice Address - Country:US
Practice Address - Phone:317-672-6400
Practice Address - Fax:317-672-6401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002508A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty