| Lakeshore Mind And Family | |
|
1329 Broadway St Ste 204 Longview WA 98632-3731 | |
| (360) 984-9018 | |
| Not Available |
| Full Name | Lakeshore Mind And Family |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 1329 Broadway St Ste 204, Longview, Washington |
| Authorized Official Name and Position | Aniezka Jenissen (OWNER) |
| Authorized Official Contact | 3609849018 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeshore Mind And Family 1329 Broadway St Ste 204 Longview WA 98632-3731 Ph: (206) 331-6660 | Lakeshore Mind And Family 1329 Broadway St Ste 204 Longview WA 98632-3731 Ph: (360) 984-9018 |
| NPI Number | 1003791971 |
|---|---|
| Provider Enumeration Date | 08/08/2025 |
| Last Update Date | 08/08/2025 |
| Certification Date | 08/08/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003791971 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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