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General NPI Number Information
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NPI Number | 1326379470
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Entity Type | Organization
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Legal Business Name | JAMES R. LANE, III
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Dates
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Enumeration Date | 01/28/2010
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Last Update Date | 01/28/2010
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Provider Practice Location Address
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Address Line | 116 LAWRENCE DR SUITE 4
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City | COLUMBUS
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State | MS
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Zip | 39702-5324
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Country | US
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Telephone | 662-329-0114
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Fax | 662-329-0114
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Provider Business Mailing Address
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Address Line | 116 LAWRENCE DR SUITE 4
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City | COLUMBUS
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State | MS
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Zip | 39702-5324
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Country | US
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Telephone | 662-329-0114
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Fax | 662-329-0114
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST/OWNER
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Name | DR. JAMES RILEY LANE III
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Credential | PHD.
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Telephone | 662-329-0114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 10140
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License Number State | MS
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