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Individual

DR. TANNEN STAHLEY-LAKE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PSYD

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
103T00000X
Psychologist
Primary
PS015411
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
ST1500807
BS#
Enumeration date
07/22/2005
Last updated
04/30/2014
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