Provider Demographics
NPI:1326379470
Name:JAMES R. LANE, III
Entity Type:Organization
Organization Name:JAMES R. LANE, III
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RILEY
Authorized Official - Last Name:LANE
Authorized Official - Suffix:III
Authorized Official - Credentials:PHD
Authorized Official - Phone:662-329-0114
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:39702-5324
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:39702-5324
Practice Address - Country:US
Practice Address - Phone:662-329-0114
Practice Address - Fax:662-329-0114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10140103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08431317Medicaid