Lake, Michael H

Lake, Michael H is an sole proprietor health care provider with primary practice located at 4450 Eau Gallie Blvd Suite 200, Melbourne FL 32934-7214. He recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Social Worker, Other Service Providers / Case Manager/Care Coordinator, Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Mental Health is his primary health care specialty. Lake, Michael H can be contacted via phone (321) 726-2860.

Contact Information

Primary practice address
4450 Eau Gallie Blvd Suite 200 Melbourne FL 32934-7214
Phone: (321) 726-2860
Fax: (321) 752-3143
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Social Worker 104100000X
Other Service Providers / Case Manager/Care Coordinator 171M00000X MH8204 Florida
Behavioral Health & Social Service Providers / Mental Health 101YM0800X MH8204 Florida

Profile Details

NPI number 1265596035
LBN Legal business name Lake, Michael H
Credentials LMHC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 19th, 2006
Last updated Sep 25th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265596035 NPPES
Florida MEDICAID 016517700
Florida MEDICAID 000761700

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