Provider Demographics
NPI:1457484347
Name:LAKEWOOD RESIDENTIAL SERVICES, INC
Entity Type:Organization
Organization Name:LAKEWOOD RESIDENTIAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYDLPC
Authorized Official - Phone:417-459-5622
Mailing Address - Street 1:1565 E BRIAR ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-7102
Mailing Address - Country:US
Mailing Address - Phone:417-882-3889
Mailing Address - Fax:417-882-3813
Practice Address - Street 1:1565 E BRIAR ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7102
Practice Address - Country:US
Practice Address - Phone:417-882-3889
Practice Address - Fax:417-882-3813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities