Provider Demographics
NPI:1568436640
Name:HOWARD, LANESA DENSES
Entity Type:Individual
Prefix:
First Name:LANESA
Middle Name:DENSES
Last Name:HOWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LANESA
Other - Middle Name:
Other - Last Name:CORBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:559 VINCENT ST
Mailing Address - Street 2:21ST MEDICAL GROUP SGHQ CREDENTIALS
Mailing Address - City:PETERSON AFB
Mailing Address - State:CO
Mailing Address - Zip Code:80914-1540
Mailing Address - Country:US
Mailing Address - Phone:719-556-1060
Mailing Address - Fax:719-556-9677
Practice Address - Street 1:559 VINCENT ST
Practice Address - Street 2:
Practice Address - City:PETERSON AFB
Practice Address - State:CO
Practice Address - Zip Code:80914-1540
Practice Address - Country:US
Practice Address - Phone:719-556-1060
Practice Address - Fax:719-556-9677
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW9924111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical