Kimmy Jo Lake, CDP

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CP60311481 Issued in WA

Practice address

758 St Helens Ave
Tacoma, WA 98402-3706

Phone

(253) 274-0484

Fax

(253) 274-1457

NPI assigned

May 14, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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 and National Provider Directory roles.

• Rainier Internal Medicine LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Puyallup, WA
  • NPI 1356716351
  NPD
• Rainier Internal Medicine LLC

  • Primary Care Clinic/Center
  • Lakewood, WA
  • NPI 1972735157
  NPD
• Pioneer Counseling Tacoma

  • Exclusive Provider Organization
  • Tacoma, WA
  • NPI 1073971933
  NPD (past)

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

{
    "created_epoch": "1368489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368489600000",
    "number": "1629414917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "758 ST HELENS AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984023706",
            "telephone_number": "253-274-0484",
            "fax_number": "253-274-1457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "758 ST HELENS AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984023706",
            "telephone_number": "253-274-0484",
            "fax_number": "253-274-1457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "KIMMY",
        "middle_name": "JO",
        "name_prefix": "Ms.",
        "credential": "CDP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-14",
        "last_updated": "2013-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP60311481",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003939034",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David C Lai, MD
• Peihsuan Lai
• Melanie Lainez, LMFT
• Catalina M Laires, BS/GMHS
• Ann Elizabeth Lake, M.S.W.
• Margaret Elizabeth Lake, RN
• Spencer Truman Lake, MD
• Lakewood Pharmacy Inc
• Lakewood Pharmacy Inc
• Manolito Lalangan

• Addiction (Substance Use Disorder) Counselor in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Addiction (Substance Use Disorder) Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2013; 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.