Provider Demographics
NPI:1467772772
Name:MAHONEY, LANEE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LANEE
Middle Name:
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BOSTON DR
Mailing Address - Street 2:
Mailing Address - City:WATONGA
Mailing Address - State:OK
Mailing Address - Zip Code:73772-1202
Mailing Address - Country:US
Mailing Address - Phone:580-614-1448
Mailing Address - Fax:
Practice Address - Street 1:104 BOSTON DR
Practice Address - Street 2:
Practice Address - City:WATONGA
Practice Address - State:OK
Practice Address - Zip Code:73772-1202
Practice Address - Country:US
Practice Address - Phone:580-614-1448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK597101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional