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General NPI Number Information
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NPI Number | 1083070676
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Entity Type | Individual
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Provider Name | EMILY ELIZABETH LAKE LMFT
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Gender | Female
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Dates
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Enumeration Date | 01/12/2016
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Last Update Date | 01/22/2016
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Provider Practice Location Address
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Address Line | 15291 NW 60TH AVE- COCONUT GROVE RECOVERY STE 201
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2460
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Country | US
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Telephone | 540-323-3579
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Fax |
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Provider Business Mailing Address
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Address Line | 6700 NW 47TH PL
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City | LAUDERHILL
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State | FL
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Zip | 33319-3402
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Country | US
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Telephone | 540-323-3579
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT 2904
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License Number State | FL
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