Individual
MR. RICHARD WAYNE LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
345 LEROY RD, HANSON, KY 42413-9657
(270) 875-2544
(270) 342-5411
Mailing address
345 LEROY RD, HANSON, KY 42413-9657
(270) 875-2544
(270) 342-5411
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
0503
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100287010
—
KY
Enumeration date
10/23/2006
Last updated
09/18/2014
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