| Organization Name: | LAKESHORE INTEGRATIVE MENTAL HEALTH SERVICES, LLC |
| NPI Number: | 1447644471 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DIANE LYNN BRUURSEMA (OWNER/CLINICAL SOCIAL WORKER) |
| Mailing Address: | 800 E Ellis Rd Mail Box 577, Suite 271 Norton Shores |
| State: | MI US |
| Postal Code: | 494415646 |
| Phone Number: | 2317994850 |
| Fax Number: | 2317994851 |
| NPI Enumeration Date: | 03/27/2015 |
| NPI Last Update Date: | 03/27/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |