Individual
MRS. ROCHELLE JEANESS LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, QMHP
Contact information
Practice address
1312 SW WASHINGTON ST, PORTLAND, OR 97208-3007
(503) 535-1150
(503) 535-1191
Mailing address
18524 NW REDWING WAY, #201, BEAVERTON, OR 97006
(503) 535-1150
(503) 535-1191
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
02/06/2007
Last updated
07/08/2007
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