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NPI Code Detail

MEDICARE: CHRISTOPHER TODD LAKE MPH,CDP

MEDICARE: CHRISTOPHER TODD LAKE MPH,CDP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorCP00004949WA

General Provider Information

NPI Number : 1114246535
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTOPHER TODD LAKE MPH,CDP
Provider Business Mailing Address
First Line : PO BOX 2429
Second Line :
City : LONGVIEW
State : WA
Zip : 98632-8486
Country : US
Telephone Number : 360-397-8228
Fax Number : 360-397-8259
Provider Business Practice Location Address
First Line : 7700 NE 26TH AVE
Second Line :
City : VANCOUVER
State : WA
Zip : 98665-0672
Country : US
Telephone Number : 360-397-8228
Fax Number : 360-397-8259
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2010
Last Update Date : 10/13/2017

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