Healthcare Provider Details

I. General information

NPI: 1013830603
Provider Name (Legal Business Name): LAKE RESILIENCE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9239 BRIARBROOK DR NE
WARREN OH
44484-1749
US

IV. Provider business mailing address

3617 ELM RD NE # 135
WARREN OH
44483-2656
US

V. Phone/Fax

Practice location:
  • Phone: 234-213-1184
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: TORI C LAKE
Title or Position: THERAPIST
Credential: LPCC
Phone: 330-647-1855