Healthcare Provider Details

I. General information

NPI: 1497801831
Provider Name (Legal Business Name): LANA RICKEY PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LANA HUNTER

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 S FAIRMONT BLVD
ANAHEIM CA
92808
US

IV. Provider business mailing address

7272 WURZBACH ROAD SUTIE 601
SAN ANTONIO TX
78240-4803
US

V. Phone/Fax

Practice location:
  • Phone: 714-998-7232
  • Fax:
Mailing address:
  • Phone: 310-984-3055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0810006031
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number36725
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number07084
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: