Organization
LAKELINE OUTPATIENT CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE CAMPBELL (DIRECTOR OF PATIENT ACCESS)
(512) 948-1752
Entity
Organization
Contact information
Practice address
1860 S LAKELINE BLVD, CEDAR PARK, TX 78613-3872
(512) 320-9003
Mailing address
1464 E WHITESTONE BLVD STE 1101, CEDAR PARK, TX 78613-9070
(512) 506-8503
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
171M00000X
Case Manager/Care Coordinator
—
—
175T00000X
Peer Specialist
—
—
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RA0401X
Addiction Medicine (Internal Medicine) Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
208VP0000X
Pain Medicine Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
04/10/2024
Last updated
10/04/2024
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