LAKE SHORE CENTER FOR BEHAVIORAL HEALTH, LLC (NPI# 1497011456) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497011456 |
| Entity Type | Organization |
| Organization Name | LAKE SHORE CENTER FOR BEHAVIORAL HEALTH, LLC |
| Practice Address |
4555 Lake Shore Dr Waco TX 76710-1814 |
| Practice Telephone | 2547760400 |
| Mailing Telephone | 2547760400 |
| Enumeration Date | 2012-04-04 |
| Last Update Date | 2012-04-04 |
| Authorized Official Name | DR. RICK PIPKIN (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 2547760400 |
| Authorized Official Credential | LPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
3023 | TX | Ambulatory Health Care Facilities |
| Y | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
9878 | TX | Ambulatory Health Care Facilities |
| Street Address |
4555 LAKE SHORE DR |
| City | WACO |
| State | TX |
| Zip Code | 76710-1814 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699765008 | Harold H Lecrone Jr. | Psychologist | 4555 Lake Shore Dr, Waco, TX 76710-1814 | 2005-10-26 |
| 1033554837 | Est 400 of Waco LLC | Clinic/Center | 4555 Lake Shore Dr, Waco, TX 76710-1814 | 2013-05-07 |
| 1174860266 | Henry David Hardt Ph D | Clinic/Center | 4555 Lake Shore Dr, Waco, TX 76710-1814 | 2013-01-09 |
| 1558624270 | Kristi Lynn Cruthirds | Social Worker | 4555 Lake Shore Dr, Waco, TX 76710-1814 | 2012-06-18 |
| 1841574209 | Kyna Baskin Lichtenstein | Social Worker | 4555 Lake Shore Dr, Waco, TX 76710-1814 | 2011-10-04 |
| 1164717393 | Diane Marie Forte | Counselor | 4555 Lake Shore Dr, Waco, TX 76710-1814 | 2011-06-15 |
| 1881989010 | Forte' Psychotherapy, Pllc | Counselor | 4555 Lake Shore Dr, Waco, TX 76710-1814 | 2011-06-15 |
| 1467599779 | Lake Shore Center for Psychological Services, P.C. | Counselor | 4555 Lake Shore Dr, Waco, TX 76710-1814 | 2007-01-30 |
| 1033109442 | Henry D Hardt | Counselor | 4555 Lake Shore Dr, Waco, TX 76710-1814 | 2005-10-26 |
| 1437149846 | Cynthia C Janecka | Social Worker | 4555 Lake Shore Dr, Waco, TX 76710-1814 | 2005-10-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740741156 | Jessica Cook-lindsay | Physical Therapist | 2121 W Hwy 6, Waco, Waco, TX 76710 | 2019-03-28 |
| 1306354824 | Paula A Huffhines | Technician, Other | 115 S 25th, Waco, TX 76710 | 2018-01-18 |
| 1982154639 | Nha Do | Pharmacist | 1301 Wood Acres, Waco, TX 76710 | 2016-10-06 |
| 1649662495 | Pediatric Advanced Life Services Home Health LLC | Home Health | 3640 W Waco Dr, Waco, TX 76710 | 2015-03-02 |
| 1881008795 | Soumava Sen, Dds, P.C. | Dentist | 4215 Franklin Ave, Ste. 300, Waco, TX 76710 | 2014-06-18 |
| 1053742221 | Dustin Dwain Kelm | Physical Therapist | 5400 Laurel Dr., Waco, TX 76710 | 2013-12-12 |
| 1881038776 | Penelope Diane Lane | Counselor | 7524 Bosque, Waco, TX 76710 | 2013-04-22 |
| 1538400627 | Erik Alexander Pernes Caluscusao | Physical Therapist | 415 Owen Ln Apt 911, Waco, TX 76710 | 2013-03-14 |
| 1447509039 | Sheree L Mach | Occupational Therapist | 5400 Laurel Lake Dr., Waco, TX 76710 | 2012-08-29 |
| 1568738425 | Ramanathan Anandaraman | Internal Medicine | 2608 Skyline Drive, Waco, TX 76710 | 2012-03-26 |
| Find all providers in zip 76710 | ||||
| Taxonomy Code | 261QM0850X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adult Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. |
| Notes: [7/1/2003: new] |
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| 1376169268 | Bolin Counseling Services Pllc | Clinic/Center | 555 Round Rock West Dr Ste E222, Round Rock, TX 78681-5052 | 2020-06-17 |
| 1376168682 | Edge of Town Productions, LLC | Clinic/Center | 746 Dayridge Dr, Dripping Springs, TX 78620-2128 | 2020-06-11 |
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| 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.