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General NPI Number Information
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NPI Number | 1750150678
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Entity Type | Organization
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Legal Business Name | LAKE AVENUE COUNSELING CENTER
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Dates
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Enumeration Date | 12/20/2023
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Last Update Date | 12/20/2023
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Provider Practice Location Address
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Address Line | 393 N LAKE AVE
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City | PASADENA
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State | CA
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Zip | 91101-1213
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Country | US
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Telephone | 626-817-4888
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Fax | 626-817-4988
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Provider Business Mailing Address
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Address Line | 393 N LAKE AVE
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City | PASADENA
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State | CA
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Zip | 91101-1213
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Country | US
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Telephone | 626-817-4888
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Fax | 626-786-4988
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Authorized Official
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Title or Position | DIRECTOR OF COUNSELING
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Name | MR. TSEGAMLAK WORKU
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Credential | MFT
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Telephone | 626-786-1019
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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 |
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License Number State |
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