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Lakeside Family Therapy Services Ltd
Multi-Specialty Clinic/Center in Racine, Wisconsin
NPI 1407998719

Lakeside Family Therapy Services Ltd is a Multi-Specialty Clinic/Center based in Racine, WI and is specialized in Multi-Specialty. Lakeside Family Therapy Services Ltd practices in Racine, WI. The NPI Number for Lakeside Family Therapy Services Ltd is 1407998719 and holds a License No. (Wisconsin).

The current practice location address for Lakeside Family Therapy Services Ltd is 4810 Northwestern Ave, Racine, WI and can be reached out via phone at 262-637-9984 and via fax at 262-637-9995.

Location: 4810 Northwestern Ave, Racine, WI, 53406-1504
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1407998719
Provider Name
Lakeside Family Therapy Services Ltd
Credential
Provider Entity Type
Organization
Address
4810 Northwestern Ave, Racine, WI, 53406-1504
Phone Number
262-637-9984
Fax Number
262-637-9995
Provider Enumeration Date
02/13/2007
Last Update Date
03/12/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
42120700 05 WI
institution
Provider Business Practice Location Address Details
Address
4810 Northwestern Ave
City
Racine
State
Wisconsin
Zip
53406
Phone Number
262-637-9984
Fax Number
262-637-9995
person
Provider Business Mailing Address Details
Address
4810 Northwestern Ave
City
Racine
State
Wisconsin
Zip
53406
Phone Number
262-637-9984
Fax Number
262-637-9995
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
101YA0400X
License No.
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Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
101YM0800X
License No.
()
Definition
Definition to come...
person
Provider's Taxonomy Details 3
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Mental Health (Including Community Mental Health Center)
Taxonomy
261QM0801X
License No.
()
Definition
Definition to come...
person
Provider's Taxonomy Details 4
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Multi-Specialty
Taxonomy
261QM1300X
License No.
()
Definition
Definition to come...
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