Jeremy William Lake

NPI #1770802431 in Cedar City, Utah

Provider Information

NPI Number: 1770802431
Entity Type: Individual
Name: Jeremy William Lake
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Counselor
Enumeration Date: May 20, 2010
Last Updated: May 20, 2010

Practice Location

Address: 6484 N 2300 W
City: Cedar City
State: Utah
ZIP Code: 84721-7102
Phone: (435) 867-4876

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor	101Y00000X	Primary

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