Provider Demographics
NPI:1740619121
Name:LAKES PSYCHIATRIC CENTER, PLLC
Entity Type:Organization
Organization Name:LAKES PSYCHIATRIC CENTER, PLLC
Other - Org Name:LPCC, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-859-2457
Mailing Address - Street 1:2300 HAGGERTY RD
Mailing Address - Street 2:SUITE 2160
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2184
Mailing Address - Country:US
Mailing Address - Phone:248-859-2457
Mailing Address - Fax:248-859-2473
Practice Address - Street 1:2300 HAGGERTY RD
Practice Address - Street 2:SUITE 2160
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2184
Practice Address - Country:US
Practice Address - Phone:248-859-2457
Practice Address - Fax:248-859-2473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-05
Last Update Date:2015-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010662002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI7200Medicare PIN