NPIMap

Organization Active NPI

Lakeshore Community Counseling Center PLLC

  • Community/Behavioral Health Agency
  • Cadillac, MI
National Provider Identifier
1225376056
Registry record updated Jan 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
6301013463 Issued in MI
Legal business name
LAKESHORE COMMUNITY COUNSELING CENTER PLLC
Practice address
9116 E 13TH St
Suite B
Cadillac, MI 49601-8126
Phone
(231) 878-3059
NPI assigned
Jan 29, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2013

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

Authorized official

Name
Dr. Craig Allen Derror, PHDNPI 1124366950
Title
Executive Director
Phone
(231) 878-3059

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 6301013463 MI Primary

Addresses

Primary practice location

9116 E 13TH St
Suite B
Cadillac, MI 49601-8126

Mailing address

9116 E 13TH St
Suite B
Cadillac, MI 49601-8126
Phone (231) 878-3059

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230213000001 MI Part B Supplier - Clinic/Group Practice 5294107652 Receives reassigned benefits from 2 practitioners
Practice locations: Cadillac, MI

National Provider Directory

National Provider Directory

Locations

9116 E 13th St
Unit B
Cadillac, MI 49601
Phone (231) 878-3059

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1359417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359417600000",
    "number": "1225376056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9116 E 13TH ST",
            "address_2": "SUITE B",
            "city": "CADILLAC",
            "state": "MI",
            "postal_code": "496018126",
            "telephone_number": "231-878-3059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9116 E 13TH ST",
            "address_2": "SUITE B",
            "city": "CADILLAC",
            "state": "MI",
            "postal_code": "496018126",
            "telephone_number": "231-878-3059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE COMMUNITY COUNSELING CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-29",
        "last_updated": "2013-01-29",
        "status": "A",
        "authorized_official_last_name": "DERROR",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "231-878-3059",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MI",
            "license": "6301013463",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cadillac, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2013; 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.