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Organization
LAKE SHORE MENTAL HEALTH SERVICES
Active
Organization
LAKE SHORE MENTAL HEALTH SERVICES
Active
Other names
Lake Shore Mental Health Services, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
ANNETTE N DIGGS PMHNP-BC (PRESIDENT)
(773) 559-0393
Entity
Organization
Contact information
Practice address
7638 S EVANS AVE STE B, CHICAGO, IL 60619-2519
(728) 201-6911
Mailing address
3685 JACKSON ST, GARY, IN 46408-1625
(872) 201-6911
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
341763684002
—
IL
Enumeration date
10/26/2020
Last updated
04/06/2021
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