Lake Behavioral Health
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Osage Beach, MO
NPI 1366037764 · NPPES record last updated Apr 21, 2021
Key facts
- NPI
- 1366037764
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- Legal business name
- LAKE BEHAVIORAL HEALTH
- Practice address
- 5529B Osage Beach Pkwy
Osage Beach, MO 65065-3023 - Phone
- (573) 693-9090
- NPI assigned
- Mar 8, 2021
- Organization subpart
- No
Authorized official
- Name
- Nicole Parker, PSYD, LP
- Title
- President
- Phone
- (573) 693-9090
Practitioners 4
-
Nicole E. Parker, PSYD
-
Kimberly Brooke Conde, PSY.D.
-
Sara Marie Harbison, LPC
-
Gwendolyn Broyles, PMHNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210312000449 | MO | Part B Supplier - Clinic/Group Practice | 5597171736 |
Receives reassigned benefits from 4 practitioners Practice locations: Osage Beach, MO |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Yes |
Addresses
Primary practice location
5529B Osage Beach Pkwy
Osage Beach, MO 65065-3023
Mailing address
PO Box 449
Osage Beach, MO 65065-0449
Phone (573) 693-9090
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 490041266 | Medicaid | MO |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | therapynotes.com |
Other providers in Osage Beach, MO
- Muthu S. Krishnan
- Jennifer A. Kuehn
- Philip J Kurle
- Brandon Joshua Labe
- Lake Area Hearing Solutions LLC
- Lake Behavioral Health Associates, LLC
- Lake Cardiovascular Institute, PC
- Lake Family Dentistry
- Lake Internal Med Special
- Lake of the Ozarks Pain Management Services, Inc
All providers in Osage Beach, MO · Mental Health Clinic/Center (Including Community Mental Health Center) in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 21, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.