Provider Demographics
NPI:1750150678
Name:LAKE AVENUE COUNSELING CENTER
Entity type:Organization
Organization Name:LAKE AVENUE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COUNSELING
Authorized Official - Prefix:MR
Authorized Official - First Name:TSEGAMLAK
Authorized Official - Middle Name:
Authorized Official - Last Name:WORKU
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:626-786-1019
Mailing Address - Street 1:393 N LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1213
Mailing Address - Country:US
Mailing Address - Phone:626-817-4888
Mailing Address - Fax:626-786-4988
Practice Address - Street 1:393 N LAKE AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1213
Practice Address - Country:US
Practice Address - Phone:626-817-4888
Practice Address - Fax:626-817-4988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty