Provider Demographics
NPI:1376577080
Name:ARMSTRONG, LANE (MS)
Entity Type:Individual
Prefix:MR
First Name:LANE
Middle Name:
Last Name:ARMSTRONG
Suffix:
Gender:M
Credentials:MS
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 115
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-0115
Mailing Address - Country:US
Mailing Address - Phone:573-348-3010
Mailing Address - Fax:575-348-1858
Practice Address - Street 1:1191 HIGHWAY KK
Practice Address - Street 2:STE. 101
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3510
Practice Address - Country:US
Practice Address - Phone:573-348-3010
Practice Address - Fax:573-348-1858
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00208103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical