Lakeside Community Committee

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

Legal business name

LAKESIDE COMMUNITY COMMITTEE

Practice address

7418 S Cottage Grove Ave
Chicago, IL 60619-1912

Phone

(773) 224-9217

Fax

(773) 224-9468

NPI assigned

May 30, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tiffany Johnson, EDD

Title

Chief Operating Officer

Phone

(773) 841-4368

Specialties & licenses 2

Addresses

Tax ID family

Lakeside Community Committee2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Lakeside Community Committee

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Chicago, IL
  • NPI 1679951917
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tiffany Jones, LPC; ED.D.

  • Professional Counselor
  • Matteson, IL
  • NPI 1790371987
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1717027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717027200000",
    "number": "1003656752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7418 S COTTAGE GROVE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606191912",
            "telephone_number": "773-224-9217",
            "fax_number": "773-224-9468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7418 S COTTAGE GROVE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606191912",
            "telephone_number": "773-224-9217",
            "fax_number": "773-224-9468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE COMMUNITY COMMITTEE",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-30",
        "last_updated": "2024-05-30",
        "certification_date": "2024-05-30",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "773-841-4368",
        "authorized_official_credential": "EDD"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lakeshore Speech, LLC
• Lakeshore Surgery Center
• Lakeshore Surgery Center
• Lakeshore Womens Health Specialists SC
• Lakeshorehealthcare
• Lakeside Community Committee
• Lakeside Dental Center
• Lakeside Dental Center
• Lakeside Dental Center Inc.
• Lakeside Eye Clinic Inc

• Adolescent and Children Mental Health Clinic/Center in Chicago, IL
• Providers in Chicago, IL by specialty
• Adolescent and Children Mental Health Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.