Healthcare Provider Details

I. General information

NPI: 1093635682
Provider Name (Legal Business Name): LAKESHORE PSYCHIATRY & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E 5TH AVE STE A
GARY IN
46402-1300
US

IV. Provider business mailing address

201 E 5TH AVE STE A
GARY IN
46402-1300
US

V. Phone/Fax

Practice location:
  • Phone: 219-791-3512
  • Fax: 877-349-7157
Mailing address:
  • Phone: 219-791-3512
  • Fax: 877-349-7157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHANNAE WATKINS
Title or Position: PMHNP
Credential: NP
Phone: 219-791-3512