Provider Demographics
NPI:1275639312
Name:LAKE-ALLEN, LESA M (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LESA
Middle Name:M
Last Name:LAKE-ALLEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6311 TABLE ROCK CIR
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-5334
Mailing Address - Country:US
Mailing Address - Phone:801-966-3306
Mailing Address - Fax:
Practice Address - Street 1:3392 W 3500 S
Practice Address - Street 2:
Practice Address - City:WEST VALLEY
Practice Address - State:UT
Practice Address - Zip Code:84119-2630
Practice Address - Country:US
Practice Address - Phone:801-969-3307
Practice Address - Fax:801-964-8898
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT367729-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional