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General NPI Number Information
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NPI Number | 1225960107
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Entity Type | Organization
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Legal Business Name | LAKESHORE MIND AND FAMILY PLLC
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Dates
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Enumeration Date | 06/02/2026
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Last Update Date | 06/02/2026
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Provider Practice Location Address
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Address Line | 1338 COMMERCE AVE STE 301
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City | LONGVIEW
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State | WA
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Zip | 98632-3726
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Country | US
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Telephone | 360-984-9018
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Fax |
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Provider Business Mailing Address
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Address Line | 1338 COMMERCE AVE STE 301
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City | LONGVIEW
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State | WA
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Zip | 98632-3726
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Country | US
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Telephone | 360-984-9018
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | ANIEZKA M JENISSEN
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Credential | LMHC
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Telephone | 360-984-9018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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