Provider Demographics
NPI:1336753235
Name:SKELTON, LANA L (LSW)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:L
Last Name:SKELTON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 E 38TH ST
Mailing Address - Street 2:BUILDING 124, ROOM 222
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46953
Mailing Address - Country:US
Mailing Address - Phone:765-674-3321
Mailing Address - Fax:260-421-1029
Practice Address - Street 1:1700 E 38TH ST
Practice Address - Street 2:BUILDING 124, ROOM 222
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953
Practice Address - Country:US
Practice Address - Phone:765-674-3321
Practice Address - Fax:260-421-1029
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86000389A101YA0400X
IN33008758A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)