Doctor Name: | MRS. ROCHELLE JEANESS LAKE |
NPI Number: | 1093854978 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, QMHP |
License Number: | |
Business Practice Address: | 1312 Sw Washington St Portland, OR - 972083007 |
Business Phone Number: | 5035351150 |
Business Fax Number: | 5035351191 |
Mailing Address: | 18524 Nw Redwing Way, #201 BEAVERTON |
State: | OR |
Postal Code: | 97006 |
Phone Number: | 5035351150 |
Fax Number: | 5035351191 |
NPI Enumeration Date: | 02/06/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |