Organization
LAKESIDE BEHAVIORAL HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ASHOK YANAMADALA M.D, (PSYCHIATRIST)
(314) 930-3520
Entity
Organization
Contact information
Practice address
4121 UNION RD, SUITE 201, SAINT LOUIS, MO 63129-1070
(314) 930-3520
Mailing address
4121 UNION RD STE 201, SAINT LOUIS, MO 63129-1070
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093269003
—
MO
01
—
MA6412
MEDICARE PTAN
MO
Enumeration date
08/08/2016
Last updated
08/19/2019
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