Organization
LAKESHORE WELLNESS AND RECOVERY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNN NOWAK LPC, CSAC (PROFESSIONAL COUNSELOR / OWNER)
(262) 305-9668
Entity
Organization
Contact information
Practice address
1519 E WASHINGTON ST STE A, WEST BEND, WI 53095-2615
(262) 305-9668
Mailing address
1519 E WASHINGTON ST STE A, WEST BEND, WI 53095-2615
(262) 305-9668
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
15917-132
WI
101YP2500X
Professional Counselor
Primary
6584-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1962748624
—
WI
Enumeration date
08/13/2018
Last updated
11/02/2020
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