NPIMap

Organization Active NPI

Lake Shore Center for Psychological Services, P.C.

  • Clinical Psychologist
  • Waco, TX
National Provider Identifier
1467599779
Registry record updated Jan 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
LAKE SHORE CENTER FOR PSYCHOLOGICAL SERVICES, P.C.
Practice address
4555 Lake Shore Dr
Waco, TX 76710-1814
Phone
(254) 776-0400
Fax
(254) 776-0637
NPI assigned
Jan 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2011

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

Authorized official

Name
Harold H Lecrone Jr., PH.D.
Title
Executive Director
Phone
(254) 776-0400

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

4555 Lake Shore Dr
Waco, TX 76710-1814

Mailing address

4555 Lake Shore Dr
Waco, TX 76710-1814
Phone (254) 776-0400

Other identifiers 1

IdentifierTypeStateIssuer
HH5047OtherTXBLUE CROSS ID NUMBER

National Provider Directory

National Provider Directory

Locations

101 W Avenue E
Valley Mills, TX 76689
Phone (254) 932-6288

Practitioners & affiliated clinicians

Practitioners 7

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": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294185600000",
    "number": "1467599779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4555 LAKE SHORE DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767101814",
            "telephone_number": "254-776-0400",
            "fax_number": "254-776-0637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4555 LAKE SHORE DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767101814",
            "telephone_number": "254-776-0400",
            "fax_number": "254-776-0637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE SHORE CENTER FOR PSYCHOLOGICAL SERVICES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2011-01-05",
        "status": "A",
        "authorized_official_last_name": "LECRONE",
        "authorized_official_first_name": "HAROLD",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "254-776-0400",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS ID NUMBER",
            "identifier": "HH5047",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waco, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2011; 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.