Provider Demographics
NPI:1437901220
Name:LAKEFRONT BEHAVIORAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:LAKEFRONT BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:L
Authorized Official - Last Name:LADNER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, NCC
Authorized Official - Phone:985-200-1223
Mailing Address - Street 1:620 GIROD ST
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-5206
Mailing Address - Country:US
Mailing Address - Phone:985-200-1223
Mailing Address - Fax:985-246-3198
Practice Address - Street 1:620 GIROD ST
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-5206
Practice Address - Country:US
Practice Address - Phone:985-200-1223
Practice Address - Fax:985-246-3198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty