Provider Demographics
NPI:1780661637
Name:MAYHEW, LANA M (MAT, LSW)
Entity Type:Individual
Prefix:MS
First Name:LANA
Middle Name:M
Last Name:MAYHEW
Suffix:
Gender:F
Credentials:MAT, LSW
Other - Prefix:MS
Other - First Name:LANA
Other - Middle Name:M
Other - Last Name:MAYHEW-SCHOMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAT, LSW
Mailing Address - Street 1:1320 WOODMAN DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45432-3497
Mailing Address - Country:US
Mailing Address - Phone:937-223-1781
Mailing Address - Fax:937-424-8656
Practice Address - Street 1:1320 WOODMAN DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45432-3497
Practice Address - Country:US
Practice Address - Phone:937-223-1781
Practice Address - Fax:937-424-8656
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS00212471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2272231Medicaid