MEDICARE: THE LAKES BEHAVIORAL HEALTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1245186154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE LAKES BEHAVIORAL HEALTH, LLC

Provider Business Mailing Address
First Line	:	420 W MAGNOLIA ST
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33815-0001
Country	:	US
Telephone Number	:	225-936-5954
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 W MAGNOLIA ST
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33815-0001
Country	:	US
Telephone Number	:	225-936-5954
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	CORY BICKHAM
Credential	:	LCDC
Telephone Number	:	225-936-5954

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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