Individual
MR. JAMES P LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LCPC
Contact information
Practice address
440 N MAIN ST APT E304, WAUCONDA, IL 60084-1759
(847) 526-6425
(847) 526-6425
Mailing address
440 N MAIN ST APT E304, WAUCONDA, IL 60084-1759
(847) 526-6425
(847) 526-6425
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
180.007410
IL
Other
Enumeration date
09/29/2011
Last updated
09/29/2011
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