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General NPI Number Information
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NPI Number | 1104754720
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Entity Type | Organization
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Legal Business Name | LAKE THERAPY SERVICES PLLC
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Dates
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Enumeration Date | 05/12/2026
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Last Update Date | 05/12/2026
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Provider Practice Location Address
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Address Line | 3501 45TH ST S STE B
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City | FARGO
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State | ND
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Zip | 58104-8955
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Country | US
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Telephone | 701-419-6948
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Fax |
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Provider Business Mailing Address
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Address Line | 3003 32ND AVE S STE 240
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City | FARGO
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State | ND
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Zip | 58103-6118
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Country | US
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Telephone | 701-419-6948
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | ERIKA LAKE
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Credential | LCSW
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Telephone | 701-219-9553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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