Organization
LAKE SHORE CENTER FOR PSYCHOLOGICAL SERVICES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HAROLD H LECRONE JR. PH.D. (EXECUTIVE DIRECTOR)
(254) 776-0400
Entity
Organization
Contact information
Practice address
4555 LAKE SHORE DR, WACO, TX 76710-1814
(254) 776-0400
(254) 776-0637
Mailing address
4555 LAKE SHORE DR, WACO, TX 76710-1814
(254) 776-0400
(254) 776-0637
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
—
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HH5047
BLUE CROSS ID NUMBER
TX
Enumeration date
01/30/2007
Last updated
01/05/2011
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