| Organization Name: | LAKE PSYCHOEDUCATIONAL CENTER |
| NPI Number: | 1417341488 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GRACE PENA (PRESIDENT) |
| Mailing Address: | 600 N Highway 27 Ste 1 Minneola |
| State: | FL US |
| Postal Code: | 347156265 |
| Phone Number: | 4072097492 |
| Fax Number: | 3522418372 |
| NPI Enumeration Date: | 03/26/2015 |
| NPI Last Update Date: | 03/26/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | MH5773 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |