| Lakeside Counseling Llc | |
|
3890 E State Road 64 Unit 1 Bradenton FL 34208-9040 | |
| (859) 457-1254 | |
| Not Available |
| Full Name | Lakeside Counseling Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3890 E State Road 64 Unit 1, Bradenton, Florida |
| Authorized Official Name and Position | Patrick R. Yewell (OWNER/MANAGER) |
| Authorized Official Contact | 8594571254 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Counseling Llc 8847 Stone Harbour Loop Bradenton FL 34212-6324 Ph: (859) 457-1254 | Lakeside Counseling Llc 3890 E State Road 64 Unit 1 Bradenton FL 34208-9040 Ph: (859) 457-1254 |
| NPI Number | 1316450554 |
|---|---|
| Provider Enumeration Date | 11/09/2017 |
| Last Update Date | 11/09/2017 |
| Medicare PECOS PAC ID | 6204197460 |
|---|---|
| Medicare Enrollment ID | O20180302002201 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316450554 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 14719 (Florida) | Primary |
| Provider Name | Patrick R Yewell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922517556 PECOS PAC ID: 7012278286 Enrollment ID: I20180302002308 |
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