Organization
LAKE PSYCHOLOGICAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TANNEN STAHLEY-LAKE PSY.D. (PSYCHOLOGIST)
(724) 465-2311
Entity
Organization
Contact information
Practice address
163 PLAZA RD, INDIANA, PA 15701-3264
(724) 465-2311
(724) 465-2339
Mailing address
163 PLAZA RD, INDIANA, PA 15701-3264
(724) 465-2311
(724) 465-2339
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS015411
PA
103TC0700X
Clinical Psychologist
PS017929
PA
1041C0700X
Clinical Social Worker
CW017359
PA
Other
Enumeration date
10/14/2015
Last updated
10/14/2015
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