Michael H Lake Jr., LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH8204 Issued in FL

Practice address

4450 Eau Gallie Blvd
Suite 200
Melbourne, FL 32934-7214

Phone

(321) 726-2860

Fax

(321) 752-3143

NPI assigned

Dec 19, 2006

Last updated

Sep 25, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lake Wellness, LLC

  • Mental Health Counselor
  • Rockledge, FL
  • NPI 1528896958
  NPD Authorized official
• Circles of Care, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Melbourne, FL
  • NPI 1922018431
  NPD (past)

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537833600000",
    "number": "1265596035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 EAST SHERIDAN RD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329013122",
            "telephone_number": "321-722-5200",
            "fax_number": "321-953-7510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4450 EAU GALLIE BLVD",
            "address_2": "SUITE 200",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329347214",
            "telephone_number": "321-726-2860",
            "fax_number": "321-752-3143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "MICHAEL",
        "middle_name": "H",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-19",
        "last_updated": "2018-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH8204",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "FL",
            "license": "MH8204",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016517700",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000761700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adinarayana M. Lagudu, MD
• Daniel Lai, MD
• Kristen Noel Lai, PA-C
• Timothy Patrick Laird, MD
• Lake Diabetes Supply, Inc
• Richard Edward Laliberte, BSC PHARM
• Vaishali Vinod Lalla, MPT
• Mary-Grace Lally
• Angela Kay Lalonde, SLP
• Victoria C Lalonde, OD

• Mental Health Counselor in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2018; 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.