Provider Demographics
NPI:1568837565
Name:LANTERN THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:LANTERN THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR - CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:B
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:240-607-2756
Mailing Address - Street 1:1282 SMALLWOOD DR W
Mailing Address - Street 2:SUITE 507
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4732
Mailing Address - Country:US
Mailing Address - Phone:240-607-2756
Mailing Address - Fax:240-607-2776
Practice Address - Street 1:8200 PROFESSIONAL PL
Practice Address - Street 2:SUITE 104
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785
Practice Address - Country:US
Practice Address - Phone:240-607-2756
Practice Address - Fax:240-607-2776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMH-1238251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health