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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