Individual
MR. DAKOTA MICHEAL LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
5441 S MACADAM AVE, PORTLAND, OR 97239-6106
(971) 415-5755
(971) 415-5855
Mailing address
4750 N ALBINA AVE APT 406, PORTLAND, OR 97217-2671
(616) 821-6584
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
L11777
OR
Other
Enumeration date
10/30/2023
Last updated
03/25/2025
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