Provider Demographics
NPI:1174499735
Name:LAKE FAMILY COUNSELING, LLC
Entity type:Organization
Organization Name:LAKE FAMILY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:LAKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCMFT, SCC-C
Authorized Official - Phone:863-843-9277
Mailing Address - Street 1:4461 BUCKINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-7221
Mailing Address - Country:US
Mailing Address - Phone:863-843-9277
Mailing Address - Fax:
Practice Address - Street 1:4461 BUCKINGHAM RD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-7221
Practice Address - Country:US
Practice Address - Phone:863-843-9277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty