Provider Demographics
NPI:1811884976
Name:LAKE MICHIGAN PSYCHOLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:LAKE MICHIGAN PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESEDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BYRNES
Authorized Official - Suffix:
Authorized Official - Credentials:LLP
Authorized Official - Phone:586-601-5495
Mailing Address - Street 1:440 W FRONT ST STE 150B
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2265
Mailing Address - Country:US
Mailing Address - Phone:231-492-0718
Mailing Address - Fax:
Practice Address - Street 1:440 W FRONT ST STE 150B
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2265
Practice Address - Country:US
Practice Address - Phone:231-492-0718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty