Provider Demographics
NPI:1801556899
Name:LAKE, JAMES EVAN (MA, PC, ATR)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EVAN
Last Name:LAKE
Suffix:
Gender:M
Credentials:MA, PC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 SOMERSET RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-4533
Mailing Address - Country:US
Mailing Address - Phone:330-780-7999
Mailing Address - Fax:
Practice Address - Street 1:843 N CLEVELAND MASSILLON RD
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-2184
Practice Address - Country:US
Practice Address - Phone:330-723-7977
Practice Address - Fax:330-239-8599
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-18
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21-169221700000X
OHC.0008277101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist