Healthcare Provider Details

I. General information

NPI: 1790477016
Provider Name (Legal Business Name): PETER VALDIS LAKIS LMSW-CC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 N TUXEDO AVE
STOCKTON CA
95204-5129
US

IV. Provider business mailing address

717 N TUXEDO AVE
STOCKTON CA
95204-5129
US

V. Phone/Fax

Practice location:
  • Phone: 207-350-5898
  • Fax:
Mailing address:
  • Phone: 207-350-5898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number138028
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: