Healthcare Provider Details

I. General information

NPI: 1013846401
Provider Name (Legal Business Name): LAKESHORE GUIDANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8046 TEAKWOOD DR
JENISON MI
49428-7766
US

IV. Provider business mailing address

8046 TEAKWOOD DR
JENISON MI
49428-7766
US

V. Phone/Fax

Practice location:
  • Phone: 616-826-3115
  • Fax:
Mailing address:
  • Phone: 616-826-3115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN L TUTTLE
Title or Position: OWNER AND THERAPIST
Credential: MA MED LPC
Phone: 616-826-3115