Lisa Lake, TREATMENT CONSULTANT

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

1776 Century Blvd NE
Atlanta, GA 30345-3397

Phone

(678) 974-2162

NPI assigned

Oct 5, 2018

Last updated

Oct 5, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Mrs. Lisa Lake Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1538697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538697600000",
    "number": "1316412364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3839 WALNUT PATH",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300384884",
            "telephone_number": "404-376-4780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1776 CENTURY BLVD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303453397",
            "telephone_number": "678-974-2162"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1175 Green St SE",
            "address_purpose": "LOCATION",
            "city": "Conyers",
            "state": "GA",
            "postal_code": "300125407",
            "country_code": "US",
            "telephone_number": "678-391-4725",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAKE",
        "first_name": "LISA",
        "credential": "TREATMENT CONSULTANT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-10-05",
        "last_updated": "2018-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": "GA",
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "GA",
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "LAKE",
            "prefix": "MRS.",
            "credential": "BEHAVIOR THERAPIST",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Trinity Laird
• Julio Rafael Lairet, D.O.
• Chantal Maxene Lajeunesse, APRN
• Ahzya Lake
• Jazzmique Marie Lake, RBT
• Makenzie Lake
• Maya Lake
• Davis Prideaux Lakeman, PA-S
• Lakewood Health Center
• Lakewood Medical

• Behavior Technician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Behavior Technician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 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.