Individual
MS. PATRICIA MARY LAKE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
2450 ALAMO AVE SE, MILAGRO PROGRAM, ALBUQUERQUE, NM 87106-3204
(505) 925-2493
(505) 925-2491
Mailing address
2800 CANDELARIA RD NW, ALBUQUERQUE, NM 87107-2915
(505) 925-2493
(505) 925-2491
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
3297
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
79973337
—
NM
Enumeration date
11/11/2005
Last updated
07/08/2007
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