Provider Demographics
NPI:1821329020
Name:LANKFORD, KEVIN LEE (MA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:LEE
Last Name:LANKFORD
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 3RD AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4732
Mailing Address - Country:US
Mailing Address - Phone:907-456-1620
Mailing Address - Fax:907-456-1614
Practice Address - Street 1:543 3RD AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4732
Practice Address - Country:US
Practice Address - Phone:907-456-1620
Practice Address - Fax:907-456-1614
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK474103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical