NPIMap

Organization Active NPI

Lake Substance Abuse Solutions LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Jeffersonville, IN
National Provider Identifier
1124598669
Registry record updated Sep 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
LAKE SUBSTANCE ABUSE SOLUTIONS LLC
Practice address
1507 Spring St
Jeffersonville, IN 47130-2939
Phone
(833) 525-3727
NPI assigned
Nov 27, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2025

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

Authorized official

Name
David Corddry
Title
Owner
Phone
(407) 622-8086

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Addiction (Substance Use Disorder) PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TA0400X
Addiction (Substance Use Disorder) Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WA0400X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

1507 Spring St
Jeffersonville, IN 47130-2939

Mailing address

225 W Canton Ave Ste 600
Winter Park, FL 32789-3181
Phone (407) 622-8086

Other practice location 1

225 W Canton Ave Ste 600
Winter Park, FL 32789-3181
Phone (833) 525-3727

Other practice location 2

1143 Fairway St Unit 110
Bowling Green, KY 42103-2452
Phone (833) 525-3727

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, KY, FL, TN4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20200615000339 IN Part B Supplier - Clinic/Group Practice 8123440401 Receives reassigned benefits from 13 practitioners
Practice locations: Jeffersonville, IN
O20200715001084 KY Part B Supplier - Clinic/Group Practice 8123440401 Receives reassigned benefits from 23 practitioners
Practice locations: Bowling Green, KY
O20220408001158 FL Part B Supplier - Clinic/Group Practice 8123440401 Receives reassigned benefits from 2 practitioners
Practice locations: Winter Park, FL
O20230605001948 TN Part B Supplier - Clinic/Group Practice 8123440401 Receives reassigned benefits from 3 practitioners
Practice locations: Clarksville, TN

National Provider Directory

National Provider Directory
Tax ID family
Lake Substance Abuse Solutions2 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.

Locations

225 W Canton Ave
Ste 600
Winter Park, FL 32789
Phone (407) 347-4536

225 W Canton Ave
Winter Park, FL 32789

510 Spring St
Ste B
Jeffersonvlle, IN 47130
Phone (833) 525-3727

1143 Fairway St
Unit 110
Bowling Green, KY 42103
Phone (833) 525-3727

1239 Woodland Dr
Ste 103
Elizabethtown, KY 42701
Phone (270) 506-2730

1860 Wilma Rudolph Blvd
Ste 127V
Clarksville, TN 37040
Phone (407) 347-4536

Practitioners & affiliated clinicians

Practitioners 32

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

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1543276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756771200000",
    "number": "1124598669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 W CANTON AVE STE 600",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327893181",
            "telephone_number": "407-622-8086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1507 SPRING ST",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "471302939",
            "telephone_number": "833-525-3727"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "225 W Canton Ave Ste 600",
            "address_purpose": "LOCATION",
            "city": "Winter Park",
            "state": "FL",
            "postal_code": "327893181",
            "country_code": "US",
            "telephone_number": "833-525-3727",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1143 Fairway St Unit 110",
            "address_purpose": "LOCATION",
            "city": "Bowling Green",
            "state": "KY",
            "postal_code": "421032452",
            "country_code": "US",
            "telephone_number": "833-525-3727",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LAKE SUBSTANCE ABUSE SOLUTIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-27",
        "last_updated": "2025-09-02",
        "certification_date": "2025-09-02",
        "status": "A",
        "authorized_official_last_name": "CORDDRY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-622-8086"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jeffersonville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.