Matthew R Lake

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

7401003468 Issued in MI

Practice address

3601 E 11 Mile Rd
Warren, MI 48092-2878

Phone

(303) 989-8169

NPI assigned

Oct 8, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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": "1570492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787184000000",
    "number": "1790326080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3601 E 11 MILE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480922878",
            "telephone_number": "303-989-8169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 E 11 MILE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480922878",
            "telephone_number": "303-989-8169"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8285 S Saginaw St Ste 7",
            "address_purpose": "LOCATION",
            "city": "Grand Blanc",
            "state": "MI",
            "postal_code": "484392436",
            "country_code": "US",
            "telephone_number": "810-321-3001",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4900 Mercury Dr Ste D",
            "address_purpose": "LOCATION",
            "city": "Dearborn",
            "state": "MI",
            "postal_code": "481262947",
            "country_code": "US",
            "telephone_number": "734-203-7675",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAKE",
        "first_name": "MATTHEW",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-08",
        "last_updated": "2026-08-20",
        "certification_date": "2026-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "MI",
            "license": "7401003468",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in Warren, MI
• Providers in Warren, MI by specialty
• Behavior Analyst in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2026; 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.