LAKE SUBSTANCE ABUSE SOLUTIONS LLC - NPI 1629900444 - Nurse Practitioner in Bowling Green, KY

Q: What is the provider's specialty?

The provider's specialty is Nurse Practitioner with taxonomy code 363LP0808X and a focus in Psychiatric/Mental Health.

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About Lake Substance Abuse Solutions Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAKE SUBSTANCE ABUSE SOLUTIONS LLC (NPI 1629900444) is a healthcare organization registered as a psychiatric/mental health in Bowling Green, Kentucky and active in the NPI registry since June 2026. The organization lists David Corddry, Owner, as its authorized official.

NPPES Registry Identity

NPI1629900444

Entity TypeOrganization

Primary Taxonomy363LP0808X

Legal Business NameLAKE SUBSTANCE ABUSE SOLUTIONS LLC

Location Address1143 FAIRWAY ST STE 103Bowling Green, KY 42103-2452

Mailing Address1143 Fairway St Ste 103Bowling Green, KY 42103-2452 · (812) 901-6881 · Fax (812) 285-8392

Phone(812) 901-6881

Fax(812) 285-8392

Organization SubpartNo

Authorized OfficialDavid CorddryOwner · (407) 622-8086

Enumeration DateJune 3, 2026

NPPES CertifiedJune 3, 2026

✔ NPI 1629900444 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0808X

1143 FAIRWAY ST STE 103, Bowling Green, KY 42103

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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ERIC SANTIAGO VELEZ CSW

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