Provider Demographics
NPI:1518744945
Name:LAKES, JENNIFER ELIZABETH (MED)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:LAKES
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:ELIZABETH
Other - Last Name:NEELEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCA
Mailing Address - Street 1:330 ASA FLAT RD
Mailing Address - Street 2:
Mailing Address - City:ANNVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40402-9036
Mailing Address - Country:US
Mailing Address - Phone:606-309-2448
Mailing Address - Fax:
Practice Address - Street 1:1501 S MAIN ST STE H
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-2091
Practice Address - Country:US
Practice Address - Phone:606-393-6695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101Y00000X
KY287614101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor