Provider Demographics
NPI:1457675225
Name:LAKE, LANA (LCPC)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:
Last Name:LAKE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:LANA
Other - Middle Name:
Other - Last Name:LAKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:420 LAKE COOK RD
Mailing Address - Street 2:SUITE 113
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5646
Mailing Address - Country:US
Mailing Address - Phone:847-331-1505
Mailing Address - Fax:
Practice Address - Street 1:420 LAKE COOK RD
Practice Address - Street 2:SUITE 113
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5646
Practice Address - Country:US
Practice Address - Phone:847-331-1505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-22
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006946101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional