Provider Demographics
NPI:1922739689
Name:LANIER, GINA (LPC)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:LANIER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8016 KNIGHTS CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-6208
Mailing Address - Country:US
Mailing Address - Phone:636-795-5457
Mailing Address - Fax:
Practice Address - Street 1:2085 BLUESTONE DR STE 210
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-6726
Practice Address - Country:US
Practice Address - Phone:636-795-5457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019043832101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health