Provider Demographics
NPI:1023580537
Name:LAKES, BETH ANN (LMHC)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:LAKES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4018 25TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-3319
Mailing Address - Country:US
Mailing Address - Phone:727-409-2091
Mailing Address - Fax:
Practice Address - Street 1:4100 W KENNEDY BLVD STE 310
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2290
Practice Address - Country:US
Practice Address - Phone:813-358-6257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-21
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH22884101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health