Lakeside Counseling LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

14719 Issued in FL

Legal business name

LAKESIDE COUNSELING LLC

Practice address

3890 E State Road 64 Unit 1
Bradenton, FL 34208-9040

Phone

(859) 457-1254

NPI assigned

Nov 9, 2017

Organization subpart

No

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

Authorized official

Name

Mr. Patrick R. Yewell, LCSWNPI 1922517556

Title

Owner/Manager

Phone

(859) 457-1254

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Patrick Radcliffe Yewell, LCSW

  • Clinical Social Worker
  • Bradenton, FL
  • NPI 1922517556
  NPD Authorized official

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

{
    "created_epoch": "1510185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510185600000",
    "number": "1316450554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8847 STONE HARBOUR LOOP",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342126324",
            "telephone_number": "859-457-1254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3890 E STATE ROAD 64 UNIT 1",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342089040",
            "telephone_number": "859-457-1254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-09",
        "last_updated": "2017-11-09",
        "status": "A",
        "authorized_official_last_name": "YEWELL",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "859-457-1254",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "FL",
            "license": "14719",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Bradenton, FL
• Providers in Bradenton, FL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2017; 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.