| Lakeside Professional Counseling, P.c. | |
|
8072 21 Mile Rd Shelby Township MI 48317-4310 | |
| (586) 932-2700 | |
| (586) 932-2705 |
| Full Name | Lakeside Professional Counseling, P.c. |
|---|---|
| Speciality | Counselor |
| Location | 8072 21 Mile Rd, Shelby Township, Michigan |
| Authorized Official Name and Position | Jessica J Lentz (PRESIDENT) |
| Authorized Official Contact | 5869322700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Professional Counseling, P.c. 8072 21 Mile Rd Shelby Township MI 48317-4310 Ph: (586) 932-2700 | Lakeside Professional Counseling, P.c. 8072 21 Mile Rd Shelby Township MI 48317-4310 Ph: (586) 932-2700 |
| NPI Number | 1073084083 |
|---|---|
| Provider Enumeration Date | 12/17/2018 |
| Last Update Date | 10/21/2023 |
| Certification Date | 10/21/2023 |
| Medicare PECOS PAC ID | 8729483078 |
|---|---|
| Medicare Enrollment ID | O20210824003131 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073084083 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Linda Shkreli-mosed |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275609430 PECOS PAC ID: 5294790424 Enrollment ID: I20041129000924 |
| Provider Name | Nicole Marie Trombley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750931473 PECOS PAC ID: 5193120301 Enrollment ID: I20210826002075 |
| Provider Name | Anne Elizabeth Rife |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972104834 PECOS PAC ID: 3678953445 Enrollment ID: I20220711002104 |
| Provider Name | Kayla Istifu |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700597259 PECOS PAC ID: 9234597162 Enrollment ID: I20230623002855 |
| Provider Name | Jessica J Lentz |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487194890 PECOS PAC ID: 2062816796 Enrollment ID: I20240110004601 |
| Provider Name | Jennifer S Laboda |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1043645120 PECOS PAC ID: 5991109530 Enrollment ID: I20240118001832 |
| Provider Name | Elizabeth Porter |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1922496702 PECOS PAC ID: 5799189429 Enrollment ID: I20240118002434 |
| Provider Name | Keith Thomas |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1235687427 PECOS PAC ID: 3173967163 Enrollment ID: I20240217000822 |
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