MEDICARE: ROMAN ANTHONY BARON LANIER

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	101YM0800X	Mental Health Counselor	0313	OK

General Provider Information

NPI Number	:	1558189662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROMAN ANTHONY BARON LANIER

Provider Business Mailing Address
First Line	:	4101 KORIE CIR
Second Line	:
City	:	MOORE
State	:	OK
Zip	:	73160-5430
Country	:	US
Telephone Number	:	405-659-8295
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 SE 22ND ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73129-8413
Country	:	US
Telephone Number	:	405-618-0150
Fax Number	:

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

Provider Enumeration Date	:	09/27/2024
Last Update Date	:	09/27/2024

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