Provider Demographics
NPI:1811238868
Name:LANAI P, PC
Entity Type:Organization
Organization Name:LANAI P, PC
Other - Org Name:SPRING ETERNAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIECHIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:405-623-1976
Mailing Address - Street 1:310 NE 28TH ST
Mailing Address - Street 2:STE. 204
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-2806
Mailing Address - Country:US
Mailing Address - Phone:405-601-4565
Mailing Address - Fax:405-601-4579
Practice Address - Street 1:310 NE 28TH ST
Practice Address - Street 2:STE. 204
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-2806
Practice Address - Country:US
Practice Address - Phone:405-601-4565
Practice Address - Fax:405-601-4579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK908101YA0400X, 251S00000X
OK1077106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200491750AMedicaid
OK200491750BMedicaid