Provider Demographics
NPI:1154476885
Name:LANE, JAMES R III (PHD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:LANE
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:116 LAWRENCE DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39702-5319
Mailing Address - Country:US
Mailing Address - Phone:662-329-0114
Mailing Address - Fax:662-329-0114
Practice Address - Street 1:116 LAWRENCE DR
Practice Address - Street 2:SUITE 4
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39702-5319
Practice Address - Country:US
Practice Address - Phone:662-329-0114
Practice Address - Fax:662-329-0114
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS10140103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115529Medicaid
MS08431317Medicaid