Provider Demographics
NPI:1407068539
Name:LAKE, VALERIE (MS)
Entity Type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:
Last Name:LAKE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:
Other - Last Name:LAKE MS LPC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:744 NW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6415
Mailing Address - Country:US
Mailing Address - Phone:541-753-9792
Mailing Address - Fax:541-753-9792
Practice Address - Street 1:744 NW 4TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6415
Practice Address - Country:US
Practice Address - Phone:541-753-9792
Practice Address - Fax:541-753-9792
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1040174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist