MEDICARE: LAKESIDECOUNSELINGWELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1518824549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKESIDECOUNSELINGWELLNESS

Provider Business Mailing Address
First Line	:	3327 WOODRIDGE DR
Second Line	:
City	:	THE VILLAGES
State	:	FL
Zip	:	32162-7502
Country	:	US
Telephone Number	:	352-461-1021
Fax Number	:

Provider Business Practice Location Address
First Line	:	8811 SCHNEIDER AVE APT 6
Second Line	:
City	:	HIGHLAND
State	:	IN
Zip	:	46322-3801
Country	:	US
Telephone Number	:	352-461-1021
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHERRI MOORE
Credential	:
Telephone Number	:	352-461-1021

Provider Enumeration Date	:	01/09/2026
Last Update Date	:	01/09/2026

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Directions to “LAKESIDECOUNSELINGWELLNESS ” Practice Location

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