Healthcare Provider Details

I. General information

NPI: 1073802351
Provider Name (Legal Business Name): LANTERN MENTAL HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 12/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 R 10
PINEVILLE WV
24874-0274
US

IV. Provider business mailing address

PO BOX 274
PINEVILLE WV
24874-0274
US

V. Phone/Fax

Practice location:
  • Phone: 304-732-0071
  • Fax: 304-732-0070
Mailing address:
  • Phone: 304-732-0071
  • Fax: 304-732-0070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1014
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number1014
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number1014
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1014
License Number StateWV
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1014
License Number StateWV
# 6
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number1014
License Number StateWV
# 7
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number1014
License Number StateWV
# 8
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number1014
License Number StateWV
# 9
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1014
License Number StateWV

VIII. Authorized Official

Name: MR. DAVID BRANDON LAWSON
Title or Position: OWNER OF LANTERN MENTAL HEALTH INC
Credential: MA-CLINICAL PSYCHOLO
Phone: 304-732-0071