Provider Demographics
NPI:1457319626
Name:LANIER, JACQUELINE (PHD LICENSED PSYCHOL)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:LANIER
Suffix:
Gender:F
Credentials:PHD LICENSED PSYCHOL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 HARDESTY AVE
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586-3832
Mailing Address - Country:US
Mailing Address - Phone:281-474-1488
Mailing Address - Fax:281-240-6481
Practice Address - Street 1:1201 HARDESTY AVE
Practice Address - Street 2:
Practice Address - City:SEABROOK
Practice Address - State:TX
Practice Address - Zip Code:77586-3832
Practice Address - Country:US
Practice Address - Phone:281-474-1488
Practice Address - Fax:281-240-6481
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2015-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30800103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0068CYOtherBC/BS
TX096507102Medicaid