Provider Demographics
NPI:1316303654
Name:LAKES, KEITH (LPCC)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:
Last Name:LAKES
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11623 HIGHWAY 3630
Mailing Address - Street 2:
Mailing Address - City:ANNVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40402-8182
Mailing Address - Country:US
Mailing Address - Phone:606-364-3640
Mailing Address - Fax:606-364-2534
Practice Address - Street 1:11623 HIGHWAY 3630
Practice Address - Street 2:
Practice Address - City:ANNVILLE
Practice Address - State:KY
Practice Address - Zip Code:40402
Practice Address - Country:US
Practice Address - Phone:606-364-3640
Practice Address - Fax:606-364-2534
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0224101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor