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General NPI Number Information
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NPI Number | 1376745448
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Entity Type | Individual
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Provider Name | CLAUDIA KATHERINE LAKE PSYD
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Gender | Female
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 08/18/2014
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Provider Practice Location Address
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Address Line | 228 NW B ST UPPER UNIT
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City | GRANTS PASS
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State | OR
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Zip | 97526-2032
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Country | US
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Telephone | 541-761-6764
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Fax | 541-592-6479
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Provider Business Mailing Address
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Address Line | PO BOX 1665
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City | CAVE JUNCTION
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State | OR
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Zip | 97523-1665
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Country | US
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Telephone | 541-761-6764
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Fax | 541-592-6479
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 16678
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2322
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License Number State | OR
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