Lakeside Family Therapy Services LTD

Primary specialty

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

Legal business name

LAKESIDE FAMILY THERAPY SERVICES LTD

Practice address

4810 Northwestern Ave
Racine, WI 53406

Phone

(262) 637-9984

Fax

(262) 637-9995

NPI assigned

Feb 13, 2007

Organization subpart

No

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

Authorized official

Name

Jacqueline V McRaeNPI 1992290381

Title

President

Phone

(262) 637-9984

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 5

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

• Renee Marie Beck-Santiago, APNP

  • Family Nurse Practitioner
  • Oak Creek, WI
  • NPI 1912276858
  Medicare reassignment Care Compare group NPD
• Pamela Jean Koonz, LCSW CSAC

  • Addiction (Substance Use Disorder) Counselor
  • Racine, WI
  • NPI 1518006667
  Medicare reassignment Care Compare group NPD
• Karla J Bidstrup, LCSW

  • Clinical Social Worker
  • Mount Pleasant, WI
  • NPI 1437485984
  Medicare reassignment NPD
• Daniel Dashner, LCSW, CSAC

  • Clinical Social Worker
  • Racine, WI
  • NPI 1144621376

  Addiction (Substance Use Disorder)

  Medicare reassignment NPD
• Jacqueline Venesia McRae, ICS, SAC-IT

  • Addiction (Substance Use Disorder) Counselor
  • Mount Pleasant, WI
  • NPI 1992290381
  NPD Authorized official

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628208000000",
    "number": "1407998719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4810 NORTHWESTERN AVE",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534061504",
            "telephone_number": "262-637-9984",
            "fax_number": "262-637-9995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4810 NORTHWESTERN AVE",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "53406",
            "telephone_number": "262-637-9984",
            "fax_number": "262-637-9995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE FAMILY THERAPY SERVICES LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2021-08-06",
        "certification_date": "2021-08-06",
        "status": "A",
        "authorized_official_last_name": "MCRAE",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "262-637-9984"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42120700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laidlaw Transit Services, Inc. D/B/a First Transit
• Robert Laing, MD
• Lake Dental Group
• Lakeshore Family Dental Care SC
• Lakeside Curative Services, Inc
• Lakeview Chiropractic and Wellness Clinic, S.C.
• Lakeview Health, LLC
• Lakeview Pharmacy in Racine SC (Lakeview Pharmacy)
• Lakeview Pharmacy in Racine SC (Lakeview LTC Pharmacy)
• Lakeview Pharmacy of Racine Inc (Lakeview LTC Pharmacy)

• Mental Health Clinic/Center (Including Community Mental Health Center) in Racine, WI
• Providers in Racine, WI by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2021; 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.