Provider Demographics
NPI:1093854978
Name:LAKE, ROCHELLE JEANESS (MA, QMHP)
Entity Type:Individual
Prefix:MRS
First Name:ROCHELLE
Middle Name:JEANESS
Last Name:LAKE
Suffix:
Gender:F
Credentials:MA, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18524 NW REDWING WAY
Mailing Address - Street 2:#201
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006
Mailing Address - Country:US
Mailing Address - Phone:503-535-1150
Mailing Address - Fax:503-535-1191
Practice Address - Street 1:1312 SW WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97208-3007
Practice Address - Country:US
Practice Address - Phone:503-535-1150
Practice Address - Fax:503-535-1191
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor