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MS. KIMMY JO LAKE CDP
NPI 1629414917
Counselor - Addiction (Substance Use Disorder) in Tacoma, WA

Active since May 14, 2013
758 ST HELENS AVE, TACOMA, WA 98402(253) 274-0484(253) 274-1457 Get Directions Write a Review

NPPES record last updated: May 14, 2013. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Ms. Kimmy Jo Lake Cdp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MS. KIMMY JO LAKE CDP (NPI 1629414917) is an individual addiction (substance use disorder) provider in Tacoma, Washington, licensed in Washington (CP60311481) and active in the NPI registry since May 2013.

NPPES Registry Identity

NPI1629414917
Entity TypeIndividualFemale
Primary Taxonomy101YA0400X
Provider Legal NameMS. KIMMY JO LAKECredential: CDP
Location Address758 ST HELENS AVETacoma, WA 98402-3706
Mailing Address758 St Helens AveTacoma, WA 98402-3706 · (253) 274-0484 · Fax (253) 274-1457
Phone(253) 274-0484
Fax(253) 274-1457
Sole ProprietorNo
Enumeration DateMay 14, 2013
✔ NPI 1629414917 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers
Taxonomy Code101YA0400X
License✔ Licensed in WA · CP60311481
758 ST HELENS AVE, Tacoma, WA 98402
Open in Google Maps ↗

Other Identifiers 1

Medicaid1003939034WA

Other Providers at the Same Location NPPES 13

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LORISSA CLOUD C.D.P.
Counselor (Addiction (Substance Use Disorder))
758 ST HELENS AVE
TACOMA, WA 98402
Pierce County (253) 274-0484
MRS. ELLEN JANELL GILBO M.S. C.C., CDP
Counselor (Addiction (Substance Use Disorder))
758 ST HELENS AVE
TACOMA, WA 98402
Pierce County (253) 274-0484
STEVEN BUTTRAM CO60766716
Counselor
758 ST HELENS AVE
TACOMA, WA 98402
Pierce County (253) 274-0484
MS. PAT A AYERS CDP
Counselor (Addiction (Substance Use Disorder))
758 ST HELENS AVE
TACOMA, WA 98402
Pierce County (253) 274-0484
MARELISE BOLDEN CDPT
Counselor (Addiction (Substance Use Disorder))
758 ST HELENS AVE
TACOMA, WA 98402
Pierce County (253) 274-0484
DOMINIQUE FORTSON-JORDAN CDP
Counselor (Addiction (Substance Use Disorder))
758 ST HELENS AVE
TACOMA, WA 98402
Pierce County (253) 274-0484
STEPHANIE LYNN LINKE BA, CDP.
Counselor (Addiction (Substance Use Disorder))
758 ST HELENS AVE
TACOMA, WA 98402
Pierce County (253) 274-0484
MAYRA GONZALEZ CDPT
Counselor (Addiction (Substance Use Disorder))
758 ST HELENS AVE
TACOMA, WA 98402
Pierce County (253) 274-0484

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kimmy Lake's NPI number?

The NPI number for Kimmy Lake is 1629414917. It was assigned to this individual provider in the NPPES registry on May 14, 2013.

Where is Kimmy Lake located?

Kimmy Lake practices at 758 St Helens Ave, Tacoma, WA 98402. The listed phone number is (253) 274-0484.

What is Kimmy Lake's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.

When was this NPI record last updated?

The NPPES record for Kimmy Lake was last updated on May 14, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.