Healthcare Provider Details

I. General information

NPI: 1811238868
Provider Name (Legal Business Name): LANAI P, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 NE 28TH ST STE. 204
OKLAHOMA CITY OK
73105-2806
US

IV. Provider business mailing address

310 NE 28TH ST STE. 204
OKLAHOMA CITY OK
73105-2806
US

V. Phone/Fax

Practice location:
  • Phone: 405-601-4565
  • Fax: 405-601-4579
Mailing address:
  • Phone: 405-601-4565
  • Fax: 405-601-4579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number908
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1077
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number908
License Number StateOK

VIII. Authorized Official

Name: DR. MARIECHIA L PALMER
Title or Position: OWNER
Credential: PHD
Phone: 405-623-1976