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General NPI Number Information
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NPI Number | 1659207694
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Entity Type | Organization
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Legal Business Name | LAKESHORE PSYCHIATRY PLLC
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Dates
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Enumeration Date | 06/18/2026
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Last Update Date | 06/18/2026
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Provider Practice Location Address
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Address Line | 6117 N WINTHROP AVE APT 3N
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City | CHICAGO
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State | IL
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Zip | 60660-2773
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Country | US
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Telephone | 224-509-9351
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Fax | 773-825-8338
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Provider Business Mailing Address
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Address Line | 2501 CHATHAM RD STE N
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4188
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Country | US
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Telephone | 224-509-9351
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Fax | 773-825-8338
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Authorized Official
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Title or Position | OWNER
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Name | CHAD CARSON
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Credential | APRN, PMHNP-BC
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Telephone | 224-509-9351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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