Individual
JEREMY WILLIAM LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6484 N 2300 W, CEDAR CITY, UT 84721-7102
(435) 867-4876
Mailing address
6484 N. 2300 W., CEDAR CITY, UT 84721
(435) 867-4876
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
05/20/2010
Last updated
05/20/2010
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