Provider Demographics
NPI:1003968678
Name:LASSETER, JAN (LPC)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:LASSETER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1001
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-7001
Mailing Address - Country:US
Mailing Address - Phone:256-582-8880
Mailing Address - Fax:256-582-8890
Practice Address - Street 1:1612 RAILROAD AVENUE
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-1111
Practice Address - Country:US
Practice Address - Phone:256-582-8880
Practice Address - Fax:256-582-8890
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1615101Y00000X
ALLPC-1615101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51520298LASOtherBCBS OF ALABAMA
AL51522539LASOtherFEDERAL BCBS