Individual
MRS. BETHANY LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
248 NE BARRY RD, KANSAS CITY, MO 64155-2722
(816) 368-8120
Mailing address
8405 NE 97TH TER, KANSAS CITY, MO 64157-7609
(816) 898-9893
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-19-36283
MO
Other
Enumeration date
06/18/2019
Last updated
06/18/2019
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