NPIMap

Organization Active NPI

Lake Psychological Services, LLC

  • Clinical Psychologist
  • Columbia, SC
National Provider Identifier
1225061971
Registry record updated Jan 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
690 Issued in SC
Legal business name
LAKE PSYCHOLOGICAL SERVICES, LLC
Practice address
115 Atrium Way
Suite #221
Columbia, SC 29223-6383
Phone
(803) 699-8887
Fax
(803) 699-8824
NPI assigned
Jul 8, 2006
Last updated
Jan 17, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Karen Downs Lake, PH.D.NPI 1487622197
Title
Owner
Phone
(803) 699-8887

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 690 SC Primary

Addresses

Primary practice location

115 Atrium Way
Suite #221
Columbia, SC 29223-6383

Mailing address

115 Atrium Way
Suite #221
Columbia, SC 29223-6383
Phone (803) 699-8887

Other identifiers 1

IdentifierTypeStateIssuer
PS0264MedicaidSC

National Provider Directory

National Provider Directory

Locations

1 Windsor Cv
Ste 108
Columbia, SC 29223
Phone (803) 699-8887

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389916800000",
    "number": "1225061971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 ATRIUM WAY",
            "address_2": "SUITE #221",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292236383",
            "telephone_number": "803-699-8887",
            "fax_number": "803-699-8824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 ATRIUM WAY",
            "address_2": "SUITE #221",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292236383",
            "telephone_number": "803-699-8887",
            "fax_number": "803-699-8824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE PSYCHOLOGICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2014-01-17",
        "status": "A",
        "authorized_official_last_name": "LAKE",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "DOWNS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "803-699-8887",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "SC",
            "license": "690",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PS0264",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.