Provider Demographics
NPI:1649797333
Name:LAKEY, JASON DAVID
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:DAVID
Last Name:LAKEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ASCOT DR STE D
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3400
Mailing Address - Country:US
Mailing Address - Phone:916-787-1100
Mailing Address - Fax:
Practice Address - Street 1:457 GRASS VALLEY HWY STE 12
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-3725
Practice Address - Country:US
Practice Address - Phone:530-888-7032
Practice Address - Fax:530-888-7067
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician