Lakeside ABA Az LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

LAKESIDE ABA AZ LLC

Practice address

4539 N 22ND St Ste R
Phoenix, AZ 85016-4639

Phone

(410) 357-1840

NPI assigned

Sep 26, 2025

Last updated

Sep 26, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Charles Williams, PSYDNPI 1366875320

Title

Ceo

Phone

(213) 435-9423

Specialties & licenses 2

Addresses

Practitioners 1

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.

• Charles Avery Williams, PSYD

  • Psychologist
  • Los Angeles, CA
  • NPI 1366875320
  Authorized official Same address or phone

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

{
    "created_epoch": "1758844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758844800000",
    "number": "1740153691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 S DOHENY DR",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900353211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4539 N 22ND ST STE R",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850164639",
            "telephone_number": "410-357-1840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE ABA AZ LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-09-26",
        "last_updated": "2025-09-26",
        "certification_date": "2025-09-26",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "213-435-9423",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Herbert Vincent Lake, D.C.
• Melissa Lake, LAC
• Melissa Ann Lake, PSY.D.
• Warren James Lake, P.T.
• Briana Danyelle Lakebrink, ATC, ITAT
• Marica Laketic, PHARMD
• Sofia Lakhdar, MD
• Howard Lakritz, M.D.
• Lakshmi DDS PLLC
• Sidney Lakusta-Wong

• Behavior Analyst in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Behavior Analyst in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2025; 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.