Organization
LAKESIDE BEHAVIORAL SOLUTIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLEOTIS WHITE M.S.W. (CEO)
(219) 801-1789
Entity
Organization
Contact information
Practice address
5944 1/2 HOHMAN AVE., HAMMOND, IN 46320
(219) 801-1789
(219) 354-0356
Mailing address
1804 E142 ST., EAST CHICAGO, IN 46312-3010
(219) 801-1789
(219) 354-0356
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1636-0-ASO
IN
Other
Enumeration date
10/08/2012
Last updated
10/08/2012
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