Provider Demographics
NPI:1710999362
Name:LAKEY, CHRISTINE M (LCSW, CEAP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:M
Last Name:LAKEY
Suffix:
Gender:F
Credentials:LCSW, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N LINDBERGH BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7844
Mailing Address - Country:US
Mailing Address - Phone:314-239-2204
Mailing Address - Fax:
Practice Address - Street 1:501 N LINDBERGH BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7844
Practice Address - Country:US
Practice Address - Phone:314-239-2204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0052001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO498898923Medicaid
MA4269OtherMEDICARE PTAN
MO00005200OtherLICENSED CLINCIAL SOCIAL WORKER NUMBER