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General NPI Number Information
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NPI Number | 1720108681
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Entity Type | Organization
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Legal Business Name | LAKESHORE EDUCATIONAL & COUNSELING SERVICES
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Dates
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Enumeration Date | 04/01/2007
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Last Update Date | 04/03/2013
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Provider Practice Location Address
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Address Line | 7007 E SPRAGUE RD STE 1
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City | INDEPENDENCE
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State | OH
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Zip | 44131-6569
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Country | US
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Telephone | 800-600-5327
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Fax | 440-963-4018
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Provider Business Mailing Address
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Address Line | 5475 LIBERTY AVE
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City | VERMILION
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State | OH
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Zip | 44089-1333
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Country | US
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Telephone | 800-600-5327
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Fax | 440-963-4018
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Authorized Official
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Title or Position | OWNER
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Name | MS. JUDI LYNN FISCHER
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Credential | LPCC
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Telephone | 440-963-0402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E4315
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License Number State | OH
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