| Lake Behavioral Health | |
|
5529b Osage Beach Pkwy Osage Beach MO 65065-3023 | |
| (573) 693-9090 | |
| Not Available |
| Full Name | Lake Behavioral Health |
|---|---|
| Speciality | Clinic/Center |
| Location | 5529b Osage Beach Pkwy, Osage Beach, Missouri |
| Authorized Official Name and Position | Nicole Parker (PRESIDENT) |
| Authorized Official Contact | 5736939090 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Behavioral Health Po Box 449 Osage Beach MO 65065-0449 Ph: (573) 693-9090 | Lake Behavioral Health 5529b Osage Beach Pkwy Osage Beach MO 65065-3023 Ph: (573) 693-9090 |
| NPI Number | 1366037764 |
|---|---|
| Provider Enumeration Date | 03/08/2021 |
| Last Update Date | 04/21/2021 |
| Certification Date | 04/21/2021 |
| Medicare PECOS PAC ID | 5597171736 |
|---|---|
| Medicare Enrollment ID | O20210312000449 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366037764 | NPI | - | NPPES |
| 490041266 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Nicole Parker |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1497201131 PECOS PAC ID: 7315228954 Enrollment ID: I20161220000523 |
| Provider Name | Kimberly Brooke Conde |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1770104044 PECOS PAC ID: 5890110241 Enrollment ID: I20200803001667 |
| Provider Name | Sara Marie Harbison |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1689090946 PECOS PAC ID: 0547618431 Enrollment ID: I20231204001395 |
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