James Evan Lake, MA, PC, ATR

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

C.0008277 Issued in OH

Practice address

843 N Cleveland Massillon Rd
Fairlawn, OH 44333-2184

Phone

(330) 723-7977

Fax

(330) 239-8599

NPI assigned

Dec 18, 2021

Sex

Male

Sole proprietor

Yes

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

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

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.

• Avenues of Counseling and Mediation

  • Mental Health Counselor
  • Medina, OH
  • NPI 1225253107
  NPD (past)

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

{
    "created_epoch": "1639785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639785600000",
    "number": "1801556899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "272 SOMERSET RD",
            "city": "AKRON",
            "state": "OH",
            "postal_code": "443134533",
            "telephone_number": "330-780-7999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "843 N CLEVELAND MASSILLON RD",
            "city": "FAIRLAWN",
            "state": "OH",
            "postal_code": "443332184",
            "telephone_number": "330-723-7977",
            "fax_number": "330-239-8599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "JAMES",
        "middle_name": "EVAN",
        "name_prefix": "Mr.",
        "credential": "MA, PC, ATR",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-12-18",
        "last_updated": "2021-12-18",
        "certification_date": "2021-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "221700000X",
            "taxonomy_group": "",
            "desc": "Art Therapist",
            "state": "OH",
            "license": "21-169",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "C.0008277",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Fairlawn, OH
• Providers in Fairlawn, OH by specialty
• Mental Health Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2021; 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.