LAKE SUBSTANCE ABUSE SOLUTIONS LLC (NPI# 1124598669) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124598669 |
| Entity Type | Organization |
| Organization Name | LAKE SUBSTANCE ABUSE SOLUTIONS LLC |
| Practice Address |
510 Spring St Jeffersonville IN 47130-3554 |
| Mailing Address |
225 W Canton Ave Ste 600 Winter Park FL 32789-3181 |
| Practice Telephone | 4076228086 |
| Mailing Telephone | 4076228086 |
| Enumeration Date | 2018-11-27 |
| Last Update Date | 2018-11-27 |
| Authorized Official Name | DAVID CORDDRY (OWNER) |
| Authorized Official Telephone | 4076228086 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103T00000X | Psychologist | Behavioral Health & Social Service Providers | ||
| N | 103TA0400X |
Psychologist Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers | ||
| N | 163WA0400X |
Registered Nurse Specialization: Addiction (Substance Use Disorder) |
Nursing Service Providers | ||
| N | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers |
| Street Address |
510 SPRING ST |
| City | JEFFERSONVILLE |
| State | IN |
| Zip Code | 47130-3554 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063415297 | Park View Psychiatric Services, Psc | Social Worker | 510 Spring St, Jeffersonville, IN 47130-3554 | 2005-05-23 |
| 1154978732 | Anna Maria Reyes-crawhorn | Nurse Practitioner | 510 Spring St, Jeffersonville, IN 47130-3554 | 2019-08-20 |
| 1144775826 | Elizabeth Ann Smoot | Nurse Practitioner | 510 Spring St, Jeffersonville, IN 47130-3554 | 2016-08-23 |
| 1871927822 | William T Lavely | Nurse Practitioner | 510 Spring St, Jeffersonville, IN 47130-3554 | 2013-08-27 |
| 1609186063 | Jessica E Meredith | Social Worker | 510 Spring St, Jeffersonville, IN 47130-3554 | 2010-10-19 |
| 1609183987 | Donna R Spears | Nurse Practitioner | 510 Spring St, Jeffersonville, IN 47130-3554 | 2010-09-08 |
| 1669791430 | James H Overfelt | Nurse Practitioner | 510 Spring St, Jeffersonville, IN 47130-3554 | 2010-05-19 |
| 1942523030 | Kathryn M Davis | Nurse Practitioner | 510 Spring St, Jeffersonville, IN 47130-3554 | 2010-03-04 |
| 1033440029 | Mary Charlene Mcandrews | Registered Nurse | 510 Spring St, Jeffersonville, IN 47130-3554 | 2010-01-15 |
| 1063747657 | Lori Michelle Paris | Social Worker | 510 Spring St, Jeffersonville, IN 47130-3554 | 2009-10-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972124717 | Jeffersonville Commons Dental | Dentist | 1019 Jeffersonville Commons Drive, Jeffersonville, IN 47130 | 2020-05-04 |
| 1467099978 | Mercury Ambulance Service Inc | Ambulance | 623 Crestview Court, Jeffersonville, IN 47130 | 2019-12-03 |
| 1427514710 | Conn Hearing Aid Center LLC | Hearing Instrument Specialist | 1516 Spring Street, Jeffersonville, IN 47130 | 2019-02-12 |
| 1619446127 | Wellness for Life | Clinic/Center | 1 Pirate Pl, Charlestown, IN 47130 | 2018-11-14 |
| 1083199939 | Stephanie Allen LLC | Dentist | 434 Patrol Road, Suite 200, Jeffersonville, IN 47130 | 2018-09-26 |
| 1679068332 | Personal Choice Inc | Day Training, Developmentally Disabled Services | 3114 Clear Stream Wat, Jeffersonville, IN 47130 | 2018-06-26 |
| 1417454638 | Jason Allen | Social Worker | 101 Noahs Ln, Jeffersonville, IN 47130 | 2018-04-13 |
| 1508374299 | Kelsey Petty | Social Worker | 101 Noahs Lane, Jeffersonville, IN 47130 | 2018-01-16 |
| 1336658095 | Jenkins Podiatry PC | Podiatrist | 3310 Highway 62 East, Suite 179, Jeffersonville, IN 47130 | 2017-09-26 |
| 1831618602 | Alyssa Marie Elliott | Physical Therapist | 3040 Gottbrath Pkwy, Jeffersonville, IN 47130 | 2017-09-13 |
| Find all providers in zip 47130 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528427929 | Lisa King | Counselor | 3072 Wooded Way, Jeffersonville, IN 47130-5993 | 2016-02-15 |
| 1528350295 | Shelly Houle Rodriguez | Counselor | 1205 Upper Pleasant Valley Rd, Jeffersonville, VT 05444 | 2011-05-12 |
| 1427371426 | Life Improvement Counseling Center LLC | Counselor | 418 Watt Street, Jeffersonville, IN 47130 | 2010-03-04 |
| 1780910778 | Ann Kathy Greer | Counselor | 2817 N Cambridge Rd, Jeffersonville, VT 05464-9871 | 2009-10-26 |
| 1871760850 | Betty Gabhart | Counselor | 525 E 7th St, Jeffersonville, IN 47130-4031 | 2008-05-09 |
| 1366564536 | Carla J Roth | Counselor | 100 W Court Ave, Suite 203, Jeffersonville, IN 47130-3502 | 2007-04-06 |
| 1700965506 | Barnett J Langford | Counselor | 1060 Sharon Dr, Jeffersonville, IN 47130-4522 | 2006-11-03 |
| 1194296400 | Alison Kay Tempero | Counselor | 1036 Sharon Dr, Jeffersonville, IN 47130-4522 | 2018-12-13 |
| 1801322961 | Julie Goin | Counselor | 1060 Sharon Dr, Jeffersonville, IN 47130-4522 | 2017-05-11 |
| 1730557422 | Denise Lynn Poukish | Counselor | 460 Spring St, Jeffersonville, IN 47130-3452 | 2015-09-11 |
| Find all providers in JEFFERSONVILLE | ||||
| City | JEFFERSONVILLE |
| Zip Code | 47130 |
Please comment or provide details below to improve the information on LAKE SUBSTANCE ABUSE SOLUTIONS LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.