Organization
LAKE SHORE CENTER FOR BEHAVIORAL HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICK PIPKIN LPC (CHIEF EXECUTIVE OFFICER)
(254) 776-0400
Entity
Organization
Contact information
Practice address
4555 LAKE SHORE DR, WACO, TX 76710-1814
(254) 776-0400
Mailing address
4555 LAKE SHORE DR, WACO, TX 76710-1814
(254) 776-0400
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
9878
TX
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
3023
TX
Other
Enumeration date
04/04/2012
Last updated
04/04/2012
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