MEDICARE: JACQUELINE LANIER PHD LICENSED PSYCHOL

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	30800	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0068CY	OTHER	TX	BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457319626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE LANIER PHD LICENSED PSYCHOL

Provider Business Mailing Address
First Line	:	1201 HARDESTY AVE
Second Line	:
City	:	SEABROOK
State	:	TX
Zip	:	77586-3832
Country	:	US
Telephone Number	:	281-474-1488
Fax Number	:	281-240-6481

Provider Business Practice Location Address
First Line	:	1201 HARDESTY AVE
Second Line	:
City	:	SEABROOK
State	:	TX
Zip	:	77586-3832
Country	:	US
Telephone Number	:	281-474-1488
Fax Number	:	281-240-6481

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	10/25/2015

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