Healthcare Provider Details

I. General information

NPI: 1275494635
Provider Name (Legal Business Name): KEGAN LAMAN MA, LAPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 BROOK ST
MOSCOW PA
18444-6008
US

IV. Provider business mailing address

700 MAIN ST # 1
DICKSON CITY PA
18519-1528
US

V. Phone/Fax

Practice location:
  • Phone: 570-483-8838
  • Fax:
Mailing address:
  • Phone: 484-797-8795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC001836
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: