NPI: 1417557968
Provider Name: LAKE SHORE MENTAL HEALTH SERVICES
Former Legal Business Name: LAKE SHORE MENTAL HEALTH SERVICES, INC.
Classification: Clinic/Center - 261QM0801X
Entity Type: Organization
Specialization: Mental Health (Including Community Mental Health Center)
Address:
7638 S EVANS AVE STE B
CHICAGO, IL
ZIP 60619
Phone: (728) 201-6911
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LAKE SHORE MENTAL HEALTH SERVICES is a mental health (including community mental health center) clinic center in Chicago, IL. LAKE SHORE MENTAL HEALTH SERVICES NPI is 1417557968. The provider is registered as an organization entity type and is a single specialty group.
The provider Former Legal Business Name Is Lake Shore Mental Health Services, Inc..
The provider's business location address is:
7638 S EVANS AVE STE B
CHICAGO, IL
ZIP 60619-519
Phone: (728) 201-6911
The provider's authorized official is Annette N Diggs .
The authorized official title is President and has the following contact phone number (773) 559-0393.
The enumeration date for this NPI number is 10/26/2020 and was last updated on 4/6/2021.