Provider Demographics
NPI:1982842167
Name:LAKES CENTER FOR YOUTH AND FAMILIES
Entity Type:Organization
Organization Name:LAKES CENTER FOR YOUTH AND FAMILIES
Other - Org Name:LAKES AREA YOUTH SERVICE BUREAU
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MADSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-464-3685
Mailing Address - Street 1:20 N LAKE STREET
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025
Mailing Address - Country:US
Mailing Address - Phone:651-464-3685
Mailing Address - Fax:651-464-3687
Practice Address - Street 1:20 N LAKE STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025
Practice Address - Country:US
Practice Address - Phone:651-464-3685
Practice Address - Fax:651-464-3687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1179101YM0800X
MN1946251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty