Provider Demographics
NPI:1346351863
Name:SPROUSE, LANA JEAN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:JEAN
Last Name:SPROUSE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47341-9446
Mailing Address - Country:US
Mailing Address - Phone:765-847-5415
Mailing Address - Fax:
Practice Address - Street 1:1401 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1908
Practice Address - Country:US
Practice Address - Phone:765-983-3000
Practice Address - Fax:765-983-3210
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004670A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN905110PPMedicare ID - Type UnspecifiedSPROUSEMEDICAREURBAN
IN231320MMMedicare ID - Type UnspecifiedSPROUSEMEDICARERURAL