Lake Shore Mental Health Services

Primary specialty

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

Legal business name

LAKE SHORE MENTAL HEALTH SERVICES

Practice address

7638 S Evans Ave Ste B
Chicago, IL 60619-2519

Phone

(728) 201-6911

NPI assigned

Oct 26, 2020

Organization subpart

No

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

Authorized official

Name

Annette N Diggs, PMHNP-BC

Title

President

Phone

(773) 559-0393

Specialties & licenses 5

Addresses

Other identifiers 1

Other names 1

• Lake Shore Mental Health Services, Inc. Former legal business name

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

{
    "created_epoch": "1603670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617667200000",
    "number": "1417557968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3685 JACKSON ST",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464081625",
            "telephone_number": "872-201-6911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7638 S EVANS AVE STE B",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606192519",
            "telephone_number": "728-201-6911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE SHORE MENTAL HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-26",
        "last_updated": "2021-04-06",
        "certification_date": "2021-04-06",
        "status": "A",
        "authorized_official_last_name": "DIGGS",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-559-0393",
        "authorized_official_credential": "PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "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": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "341763684002",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Shore Mental Health Services, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Lake Shore Medical Associates LTD
• Lake Shore Medical Associates, LTD.
• Lake Shore Medical Consultants, S.C.
• Lake Shore Medical Services
• Lake Shore Medicar, Inc.
• Lake Shore Plastic Surgery
• Lake Shore Podiatry Center, LLC
• Lake Shore Podiatry Center, LLC
• Lake Shore Podiatry Center, LLC
• Lake Shore Podiatry Center, LLC

• Mental Health Clinic/Center (Including Community Mental Health Center) in Chicago, IL
• Providers in Chicago, IL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Illinois

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