NPIMap

Organization Active NPI

Lakeshore Therapy PLLC

  • Clinical Social Worker
  • Sandusky, MI
National Provider Identifier
1699180901
Registry record updated Nov 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801080601 Issued in MI
Legal business name
LAKESHORE THERAPY PLLC
Practice address
51 Austin St
Sandusky, MI 48471-1244
Phone
(810) 689-4846
Fax
(810) 958-1430
NPI assigned
Jun 25, 2014
Last updated
Nov 1, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2024

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

Authorized official

Name
Helena Witkowski, LMSW, ACSWNPI 1548294895
Title
Owner, Lakeshore Therapy PLLC
Phone
(810) 689-4846

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 6801080601 MI Primary

Addresses

Primary practice location

51 Austin St
Sandusky, MI 48471-1244

Mailing address

51 Austin St
Sandusky, MI 48471-1244
Phone (810) 689-4846

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140902000502 MI Part B Supplier - Clinic/Group Practice 9133347354 Receives reassigned benefits from 7 practitioners
Practice locations: Lexington, MI; Sandusky, MI; Bad Axe, MI

National Provider Directory

National Provider Directory

Locations

1115 S Van Dyke Rd
Ste 1
Bad Axe, MI 48413
Phone (810) 689-4846

805 S Van Dyke Rd
Ste C
Bad Axe, MI 48413
Phone (810) 689-4846

51 Austin St
Sandusky, MI 48471
Phone (810) 648-5244

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1403654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730419200000",
    "number": "1699180901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51 AUSTIN ST",
            "city": "SANDUSKY",
            "state": "MI",
            "postal_code": "484711244",
            "telephone_number": "810-689-4846",
            "fax_number": "810-958-1430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 AUSTIN ST",
            "city": "SANDUSKY",
            "state": "MI",
            "postal_code": "484711244",
            "telephone_number": "810-689-4846",
            "fax_number": "810-958-1430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-25",
        "last_updated": "2024-11-01",
        "certification_date": "2024-11-01",
        "status": "A",
        "authorized_official_last_name": "WITKOWSKI",
        "authorized_official_first_name": "HELENA",
        "authorized_official_title_or_position": "OWNER, LAKESHORE THERAPY PLLC",
        "authorized_official_telephone_number": "810-689-4846",
        "authorized_official_credential": "LMSW, ACSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801080601",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sandusky, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2024; 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.