Lakeside Mental Health PLLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

LAKESIDE MENTAL HEALTH PLLC

Practice address

96 Beach Walk Blvd Ste 208
Conroe, TX 77304-4549

Phone

(281) 393-4692

NPI assigned

Nov 3, 2021

Organization subpart

No

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

Authorized official

Name

Michael Graves, APRN, PMHNP-BCNPI 1437692282

Title

Owner

Phone

(281) 393-4692

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

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

• Michael Alan Graves, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Conroe, TX
  • NPI 1437692282
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1635897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635897600000",
    "number": "1801551981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "96 BEACH WALK BLVD STE 208",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773044549",
            "telephone_number": "281-393-4692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "96 BEACH WALK BLVD STE 208",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773044549",
            "telephone_number": "281-393-4692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE MENTAL HEALTH PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-03",
        "last_updated": "2021-11-03",
        "certification_date": "2021-11-03",
        "status": "A",
        "authorized_official_last_name": "GRAVES",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "281-393-4692",
        "authorized_official_credential": "APRN, PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ngozi Grace Ladokun, FNP-C
• Kayla Renee Lair
• Lake Conroe Dentistry, PC
• Lake Point Vision PLLC
• Lakeside Gastroenterology and Liver Specialists, PLLC
• Kiran Lakhian
• Hang Tuyet Lam, OD
• Cassandra Lambert
• Lee Butcher Lancaster, LPC
• Lorrel Lancaster

• Psychiatric/Mental Health Nurse Practitioner in Conroe, TX
• Providers in Conroe, TX by specialty
• Psychiatric/Mental Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2021; 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.