Provider Demographics
NPI:1902069552
Name:LAKE AREA CITIZENS' ADVISORY BOARD, INC.
Entity Type:Organization
Organization Name:LAKE AREA CITIZENS' ADVISORY BOARD, INC.
Other - Org Name:LAKE AREA COUNSELING & BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:HOOKER
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC, FNP-BC
Authorized Official - Phone:573-317-9061
Mailing Address - Street 1:409R W US HIGHWAY 54
Mailing Address - Street 2:
Mailing Address - City:CAMDENTON
Mailing Address - State:MO
Mailing Address - Zip Code:65020-6948
Mailing Address - Country:US
Mailing Address - Phone:573-317-9061
Mailing Address - Fax:573-317-1970
Practice Address - Street 1:409R W US HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:CAMDENTON
Practice Address - State:MO
Practice Address - Zip Code:65020-6948
Practice Address - Country:US
Practice Address - Phone:573-317-9061
Practice Address - Fax:573-317-1970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO273370857Medicaid