Lake'S Edge Therapy Services LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

LAKE'S EDGE THERAPY SERVICES LLC

Practice address

212 1/2 Washington Ave Ste 3
Grand Haven, MI 49417-3316

Phone

(616) 419-8591

NPI assigned

Aug 15, 2023

Organization subpart

No

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

Authorized official

Name

Catherine Anne Kolacz, LMSWNPI 1134396427

Title

Owner

Phone

(616) 502-4586

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

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

• Catherine Anne Kolacz

  • Clinical Social Worker
  • Grand Haven, MI
  • NPI 1134396427
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1692057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693008000000",
    "number": "1164205159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "59 N DIVISION AVE",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494246456",
            "telephone_number": "616-502-4586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 1/2 WASHINGTON AVE STE 3",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494173316",
            "telephone_number": "616-419-8591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE'S EDGE THERAPY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-15",
        "last_updated": "2023-08-26",
        "certification_date": "2023-08-26",
        "status": "A",
        "authorized_official_last_name": "KOLACZ",
        "authorized_official_first_name": "CATHERINE",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-502-4586",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• L Michael Sterenberg DO PLLC
• Lauren Cathryn L'Huillier, DPT
• Morgan E. Lachney, ED.D., PSY.D.
• Rebecca Lacour, FNP-BC
• Lake Michigan Endodontics of Grand Haven PLLC
• Lakeshore Coordinating Council
• Lakeshore Ear and Hearing Associates LLC
• Lakeshore Urology PLC
• Elizabeth Lam
• Kaitlyn Michele Lamphere, AT, ATC

• Clinical Social Worker in Grand Haven, MI
• Providers in Grand Haven, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2023; 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.