MEDICARE: LISA LANEY LMFT, LPC

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	101Y00000X	Counselor	A1606082	AR
2	101Y00000X	Counselor	M1905004	AR
3	101YM0800X	Mental Health Counselor	P1905060	AR

General Provider Information

NPI Number	:	1528511151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA LANEY LMFT, LPC

Provider Business Mailing Address
First Line	:	472592 E 1120 RD
Second Line	:
City	:	MULDROW
State	:	OK
Zip	:	74948-5576
Country	:	US
Telephone Number	:	479-459-7193
Fax Number	:

Provider Business Practice Location Address
First Line	:	4943 OLD GREENWOOD RD STE 6
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-6923
Country	:	US
Telephone Number	:	479-459-7193
Fax Number	:

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

Provider Enumeration Date	:	08/01/2016
Last Update Date	:	06/03/2019

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