Owens & Lake Wellness & Counseling, Inc.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH8204 Issued in FL

Legal business name

OWENS & LAKE WELLNESS & COUNSELING, INC.

Practice address

1209 Admiralty Blvd
Rockledge, FL 32955

Phone

(321) 632-5155

Fax

(321) 632-5613

NPI assigned

Mar 22, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Michael Henry Lake Jr., M.S., LMHC

Title

President

Phone

(321) 632-5155

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1356467237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1209 ADMIRALTY BLVD",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "32955",
            "telephone_number": "321-632-5155",
            "fax_number": "321-632-5613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1209 ADMIRALTY BLVD",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "32955",
            "telephone_number": "321-632-5155",
            "fax_number": "321-632-5613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OWENS & LAKE WELLNESS & COUNSELING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LAKE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "HENRY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "321-632-5155",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.S., LMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH8204",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH7448",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.