Provider Demographics
NPI:1598829616
Name:LAKE ERIE COUNSELING INC
Entity Type:Organization
Organization Name:LAKE ERIE COUNSELING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:ALLGEIER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:814-455-4009
Mailing Address - Street 1:301 WEST 10TH STREET
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-1440
Mailing Address - Country:US
Mailing Address - Phone:814-455-4009
Mailing Address - Fax:814-455-7715
Practice Address - Street 1:301 WEST 10TH STREET
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-1440
Practice Address - Country:US
Practice Address - Phone:814-455-4009
Practice Address - Fax:814-455-7715
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKE ERIE COUNSELING INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-21
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 1041C0700X
PACW7163L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA089804Medicare UPIN