MEDICARE: STACY LAKE

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
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1912160847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY LAKE

Provider Business Mailing Address
First Line	:	PO BOX 2187
Second Line	:
City	:	SYLVA
State	:	NC
Zip	:	28779-2187
Country	:	US
Telephone Number	:	828-631-3973
Fax Number	:	828-631-9280

Provider Business Practice Location Address
First Line	:	154 MEDICAL PARK LOOP
Second Line	:
City	:	SYLVA
State	:	NC
Zip	:	28779-5271
Country	:	US
Telephone Number	:	828-631-3973
Fax Number	:	828-631-9280

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2008
Last Update Date	:	03/17/2016

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1700730843 — MEAGAN WILLIAMS
Practice Location Address:

154 MEDICAL PARK LOOP # A
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28779-5271

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1902955958 — MR. STEVEN BRENT MCRAE LCSW
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154 MEDICAL PARK LOOP
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1356490247 — MS. LISA NEFF BROWN LPC
Practice Location Address:

154 MEDICAL PARK LOOP
SYLVA, NC
28779-5271

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Practice Fax: 828-631-9280

1790830636 — JAI R KUMAR M.D.
Practice Location Address:

154 MEDICAL PARK LOOP STE A
SYLVA, NC
28779-5271

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1629104641 — MR. SHAWN KEITH HARTZOG LPA
Practice Location Address:

154 MEDICAL PARK LOOP
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28779-5271

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1912196452 — STEPHEN MAYFIELD B.S.
Practice Location Address:

154 MEDICAL PARK LOOP
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28779-5271

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Directions to “ STACY LAKE ” Practice Location

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