Provider Demographics
NPI:1174280705
Name:LANHAM, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:LANHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22157 NW 87TH AVENUE RD
Mailing Address - Street 2:
Mailing Address - City:MICANOPY
Mailing Address - State:FL
Mailing Address - Zip Code:32667-7439
Mailing Address - Country:US
Mailing Address - Phone:502-299-2282
Mailing Address - Fax:
Practice Address - Street 1:22157 NW 87TH AVENUE RD
Practice Address - Street 2:
Practice Address - City:MICANOPY
Practice Address - State:FL
Practice Address - Zip Code:32667-7439
Practice Address - Country:US
Practice Address - Phone:502-299-2282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health