| Lake Substance Abuse Solutions Llc | |
|
1507 Spring St Jeffersonville IN 47130-2939 | |
| (833) 525-3727 | |
| Not Available |
| Full Name | Lake Substance Abuse Solutions Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 1507 Spring St, Jeffersonville, Indiana |
| Authorized Official Name and Position | David Corddry (OWNER) |
| Authorized Official Contact | 4076228086 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Substance Abuse Solutions Llc 225 W Canton Ave Ste 600 Winter Park FL 32789-3181 Ph: (407) 622-8086 | Lake Substance Abuse Solutions Llc 1507 Spring St Jeffersonville IN 47130-2939 Ph: (833) 525-3727 |
| NPI Number | 1124598669 |
|---|---|
| Provider Enumeration Date | 11/27/2018 |
| Last Update Date | 11/09/2022 |
| Certification Date | 11/09/2022 |
| Medicare PECOS PAC ID | 8123440401 |
|---|---|
| Medicare Enrollment ID | O20200615000339 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124598669 | NPI | - | NPPES |
| Provider Name | Joy L Knopfmeier |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568469542 PECOS PAC ID: 9032017546 Enrollment ID: I20041006000655 |
| Provider Name | Larry P Mudd |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245237122 PECOS PAC ID: 4789754888 Enrollment ID: I20080602000312 |
| Provider Name | Steven Shelton |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215934310 PECOS PAC ID: 6406754910 Enrollment ID: I20110930000216 |
| Provider Name | Tracie L Anderson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407859465 PECOS PAC ID: 6608041850 Enrollment ID: I20111216000170 |
| Provider Name | William T Lavely |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871927822 PECOS PAC ID: 2860627635 Enrollment ID: I20140113000539 |
| Provider Name | Carolyn Britt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053389197 PECOS PAC ID: 3779878970 Enrollment ID: I20160826002197 |
| Provider Name | Anna Reyes-crawhorn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154978732 PECOS PAC ID: 5092043067 Enrollment ID: I20190829000408 |
| Provider Name | Jami S Hughes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205870680 PECOS PAC ID: 2668469560 Enrollment ID: I20200615001013 |
| Provider Name | Jennifer Parr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710361530 PECOS PAC ID: 0446552038 Enrollment ID: I20201130002748 |
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