Provider Demographics
NPI:1679197651
Name:LAKE AREA TMS
Entity Type:Organization
Organization Name:LAKE AREA TMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PHAETRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RANEY
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, LCSW
Authorized Official - Phone:832-363-7877
Mailing Address - Street 1:19901 SOUTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-6538
Mailing Address - Country:US
Mailing Address - Phone:832-363-7877
Mailing Address - Fax:
Practice Address - Street 1:1 LAKESHORE DR STE 130
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70629-0100
Practice Address - Country:US
Practice Address - Phone:832-363-7877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center