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General NPI Number Information
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NPI Number | 1699829168
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Entity Type | Individual
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Provider Name | RICHARD D LAKE M.S., LMHC
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Gender | Male
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10116 116TH ST E SUITE 202
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City | PUYALLUP
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State | WA
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Zip | 98373-3543
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Country | US
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Telephone | 253-904-8592
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Fax | 253-904-8592
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Provider Business Mailing Address
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Address Line | 10115 63RD AVENUE CT E
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City | PUYALLUP
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State | WA
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Zip | 98373-1165
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Country | US
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Telephone | 253-904-8592
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Fax | 253-904-8592
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH00005258
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License Number State | WA
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