Provider Demographics
NPI:1851439905
Name:LAKESHORE COUNSELING LLC
Entity Type:Organization
Organization Name:LAKESHORE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAGRATH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:480-610-1625
Mailing Address - Street 1:1845 S DOBSON RD
Mailing Address - Street 2:STE 104
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-5661
Mailing Address - Country:US
Mailing Address - Phone:480-610-1625
Mailing Address - Fax:480-610-1632
Practice Address - Street 1:1845 S DOBSON RD
Practice Address - Street 2:STE 104
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-5661
Practice Address - Country:US
Practice Address - Phone:480-610-1625
Practice Address - Fax:480-610-1632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 1982101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty