| Organization Name: | LAKEVIEW FAMILY COUNSELING CENTER LLC |
| NPI Number: | 1407289374 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHIRLEY JO WILSON (OWNER) |
| Mailing Address: | 765 Manitou Road Manitou Beach |
| State: | MI US |
| Postal Code: | 49253 |
| Phone Number: | 5174034950 |
| Fax Number: | 5172525135 |
| NPI Enumeration Date: | 08/15/2013 |
| NPI Last Update Date: | 08/15/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 6401011390 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |