| Doctor Name: | MR. JAMES P LAKE |
| NPI Number: | 1518241330 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MS, LCPC |
| License Number: | 180.007410 |
| Business Practice Address: | 440 N Main St Apt E304 Wauconda, IL - 600841759 |
| Business Phone Number: | 8475266425 |
| Business Fax Number: | 8475266425 |
| Mailing Address: | 440 N Main St Apt E304, WAUCONDA |
| State: | IL |
| Postal Code: | 600841759 |
| Phone Number: | 8475266425 |
| Fax Number: | 8475266425 |
| NPI Enumeration Date: | 09/29/2011 |
| NPI Last Update Date: | 09/29/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 180.007410 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |