Provider Demographics
NPI:1083423453
Name:LAKESIDE COUNSELING SERVICES
Entity type:Organization
Organization Name:LAKESIDE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:636-887-3655
Mailing Address - Street 1:1031A PERUQUE CROSSING CT
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-2384
Mailing Address - Country:US
Mailing Address - Phone:636-887-3655
Mailing Address - Fax:636-887-3655
Practice Address - Street 1:1031A PERUQUE CROSSING CT
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2384
Practice Address - Country:US
Practice Address - Phone:636-887-3655
Practice Address - Fax:636-887-3655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty