Provider Demographics
NPI:1427676600
Name:LAKESIDE COUNSELING CENTER, LLC
Entity type:Organization
Organization Name:LAKESIDE COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICSW/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMI
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:801-792-4832
Mailing Address - Street 1:PO BOX 1146
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98009-1146
Mailing Address - Country:US
Mailing Address - Phone:801-792-4832
Mailing Address - Fax:
Practice Address - Street 1:1600 2ND AVE APT 1803
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-3288
Practice Address - Country:US
Practice Address - Phone:425-202-5093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty