| Lakeside Behavioral Health, Llc | |
|
4121 Union Rd Suite 201 Saint Louis MO 63129-1070 | |
| (314) 930-3520 | |
| Not Available |
| Full Name | Lakeside Behavioral Health, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4121 Union Rd, Saint Louis, Missouri |
| Authorized Official Name and Position | Ashok Yanamadala (PSYCHIATRIST) |
| Authorized Official Contact | 3149303520 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Behavioral Health, Llc 4121 Union Rd Ste 201 Saint Louis MO 63129-1070 Ph: () - | Lakeside Behavioral Health, Llc 4121 Union Rd Suite 201 Saint Louis MO 63129-1070 Ph: (314) 930-3520 |
| NPI Number | 1093269003 |
|---|---|
| Provider Enumeration Date | 08/08/2016 |
| Last Update Date | 08/19/2019 |
| Medicare PECOS PAC ID | 9436439510 |
|---|---|
| Medicare Enrollment ID | O20161207000371 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093269003 | NPI | - | NPPES |
| MA6412 | Other | MO | MEDICARE PTAN |
| 1093269003 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Ashok Yanamadala |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558418301 PECOS PAC ID: 7214957349 Enrollment ID: I20051202000717 |
| Provider Name | Sheila Barnes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811195035 PECOS PAC ID: 5698050300 Enrollment ID: I20170321000529 |
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