Jennifer Marie Lake, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

4704248401 Issued in MI

Practice address

1346 Baldwin St
Jenison, MI 49428-8937

Phone

(616) 765-8585

NPI assigned

Jun 16, 2013

Last updated

Sep 9, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Tahoma Enterprises LLC

  dba Tahoma Counseling

  • Social Worker
  • Jenison, MI
  • NPI 1366009961
  NPD
• Divine Mind Counseling and Consulting Services

  • Mental Health Counselor
  • Grand Rapids, MI
  • NPI 1013523976
  NPD (past)

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

{
    "created_epoch": "1371340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788912000000",
    "number": "1285073924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5638 LINEDRIVE CT NE",
            "city": "COMSTOCK PARK",
            "state": "MI",
            "postal_code": "493219626",
            "telephone_number": "616-540-1930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1346 BALDWIN ST",
            "city": "JENISON",
            "state": "MI",
            "postal_code": "494288937",
            "telephone_number": "616-765-8585"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2730 5 Mile Rd NE Ste 101",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495256518",
            "country_code": "US",
            "telephone_number": "616-426-9401",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3300 36th St SE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495122810",
            "country_code": "US",
            "telephone_number": "616-942-2110",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAKE",
        "first_name": "JENNIFER",
        "middle_name": "MARIE",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-16",
        "last_updated": "2026-09-09",
        "certification_date": "2026-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MI",
            "license": "4704248401",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704248401",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Knowlton, PHARM.D.
• Tracy Lynn Kroeger, PHD
• Martin Robert Kugel Jr, RPH
• Kaila Ann Kulczyski
• Stephanie Ann Laidlaw
• Lakeshore Chiropractic, Inc.
• Lakeshore Guidance LLC
• David Laman, PH.D.
• Amanda Lane
• Renee Lanning, RN

• Psychiatric/Mental Health Nurse Practitioner in Jenison, MI
• Providers in Jenison, MI by specialty
• Psychiatric/Mental Health Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.