Lakeshore Wellness and Recovery Inc

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6584-125 Issued in WI

Legal business name

LAKESHORE WELLNESS AND RECOVERY INC

Practice address

1519 E Washington St Ste a
West Bend, WI 53095-2615

Phone

(262) 305-9668

NPI assigned

Aug 13, 2018

Organization subpart

No

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

Authorized official

Name

Lynn Nowak, LPC, CSACNPI 1962748624

Title

Professional Counselor / Owner

Phone

(262) 305-9668

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Lynn Nowak, LPC, CSAC

  • Professional Counselor
  • West Bend, WI
  • NPI 1962748624

  Addiction (Substance Use Disorder)

  NPD (past) Authorized official

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

{
    "created_epoch": "1534118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604275200000",
    "number": "1609355452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1519 E WASHINGTON ST STE A",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530952615",
            "telephone_number": "262-305-9668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1519 E WASHINGTON ST STE A",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530952615",
            "telephone_number": "262-305-9668"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11512 W Port Washington Rd",
            "address_2": "Suite 201E",
            "address_purpose": "LOCATION",
            "city": "Mequon",
            "state": "WI",
            "postal_code": "53092",
            "country_code": "US",
            "telephone_number": "262-305-9668",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1228 Highway 33",
            "address_purpose": "LOCATION",
            "city": "West Bend",
            "state": "WI",
            "postal_code": "53095",
            "country_code": "US",
            "telephone_number": "262-305-9668",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LAKESHORE WELLNESS AND RECOVERY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-13",
        "last_updated": "2020-11-02",
        "certification_date": "2020-11-02",
        "status": "A",
        "authorized_official_last_name": "NOWAK",
        "authorized_official_first_name": "LYNN",
        "authorized_official_title_or_position": "PROFESSIONAL COUNSELOR / OWNER",
        "authorized_official_telephone_number": "262-305-9668",
        "authorized_official_credential": "LPC, CSAC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "15917-132",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "6584-125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1962748624",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John P Lacey Jr.
• Christina M Lachner, M.S., LPC-IT
• Ladybugs Home Care Services LLC
• Carrie Lake, HIS
• Lakeshore Community Health Care, Inc
• Liliya Lakshtanov
• Patricia L Landvatter
• Patricia D Lane
• Abbey Lang
• Shelly Ann Lang, OTR

• Professional Counselor in West Bend, WI
• Providers in West Bend, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2020; 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.