Provider Demographics
NPI:1245636430
Name:LAKESIDE COUNSELING
Entity type:Organization
Organization Name:LAKESIDE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:BUFFI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-703-7911
Mailing Address - Street 1:PO BOX 70042
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84170-0042
Mailing Address - Country:US
Mailing Address - Phone:801-703-7911
Mailing Address - Fax:
Practice Address - Street 1:2832 W 4700 S
Practice Address - Street 2:SUITE A
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-2155
Practice Address - Country:US
Practice Address - Phone:801-703-7911
Practice Address - Fax:866-614-0752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-14
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT351724-35011041C0700X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty