Basic Information
| Provider Information | |||||||||
| NPI: | 1023580537 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAKES | ||||||||
| FirstName: | BETH | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | RMHCI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4018 25TH AVE N | ||||||||
| Address2: | |||||||||
| City: | SAINT PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337133319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274092091 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8800 49TH ST N STE 106 | ||||||||
| Address2: | |||||||||
| City: | PINELLAS PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337825332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275440044 | ||||||||
| FaxNumber: | 7275450125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2018 | ||||||||
| LastUpdateDate: | 12/21/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 17636 | FL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.