Provider Demographics
NPI:1902625205
Name:LGC SERVICES LLC
Entity type:Organization
Organization Name:LGC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:507-438-7603
Mailing Address - Street 1:102 1ST AVE NE STE 1
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-3401
Mailing Address - Country:US
Mailing Address - Phone:507-396-2162
Mailing Address - Fax:
Practice Address - Street 1:102 1ST AVE NE STE 1
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-3401
Practice Address - Country:US
Practice Address - Phone:507-396-2162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1235211160Medicaid
MN1578658282Medicaid