Lake, Candice M

Lake, Candice M is an individual health care provider with primary practice located at 1260 Ekhart St Ne , Grand Rapids MI 49503-1380. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Psychologist, Behavioral Health & Social Service Providers / Behavioral Analyst. Behavioral Health & Social Service Providers / Behavioral Analyst is her primary health care specialty. Lake, Candice M can be contacted via phone (616) 965-3470.

Contact Information

Primary practice address
1260 Ekhart St Ne Grand Rapids MI 49503-1380
Phone: (616) 965-3470
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X 6301016173 Michigan
Behavioral Health & Social Service Providers / Behavioral Analyst 103K00000X 01-07-3561 Michigan

Profile Details

NPI number 1285918193
LBN Legal business name Lake, Candice M
Credentials BCBA-D, LLP
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 11th, 2011
Last updated Mar 21st, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1285918193 NPPES
Nebraska MEDICAID 10025695700

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