MEDICARE: BEN LANPHER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	2000160891	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063593499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEN LANPHER PH.D.

Provider Business Mailing Address
First Line	:	19103 STATE HIGHWAY C
Second Line	:
City	:	ADVANCE
State	:	MO
Zip	:	63730-8070
Country	:	US
Telephone Number	:	573-722-5797
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 SOUTH PRAIRIE
Second Line	:
City	:	BLOOMFIELD
State	:	MO
Zip	:	63825-0500
Country	:	US
Telephone Number	:	573-895-2145
Fax Number	:	573-895-2146

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	07/08/2007

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Directions to “ BEN LANPHER PH.D.” Practice Location

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