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Organization

LAKESIDE COUNSELING LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. PATRICK R. YEWELL LCSW (OWNER/MANAGER)
(859) 457-1254
Entity
Organization

Contact information

Practice address
3890 E STATE ROAD 64 UNIT 1, BRADENTON, FL 34208-9040
(859) 457-1254
Mailing address
8847 STONE HARBOUR LOOP, BRADENTON, FL 34212-6324
(859) 457-1254

Taxonomy

Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
14719
FL

Other

Enumeration date
11/09/2017
Last updated
11/09/2017
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