Provider Demographics
NPI:1720108681
Name:LAKESHORE EDUCATIONAL & COUNSELING SERVICES
Entity Type:Organization
Organization Name:LAKESHORE EDUCATIONAL & COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:440-963-0402
Mailing Address - Street 1:5475 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089-1333
Mailing Address - Country:US
Mailing Address - Phone:800-600-5327
Mailing Address - Fax:440-963-4018
Practice Address - Street 1:7007 E SPRAGUE RD STE 1
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-6569
Practice Address - Country:US
Practice Address - Phone:800-600-5327
Practice Address - Fax:440-963-4018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-01
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE4315101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty