Provider Demographics
NPI:1871130195
Name:WHITEHEAD, LANA L (MS, LPC)
Entity type:Individual
Prefix:
First Name:LANA
Middle Name:L
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:LANA
Other - Middle Name:L
Other - Last Name:GILBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PLPC
Mailing Address - Street 1:2885 W BATTLEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-3952
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:112 N STATE HIGHWAY 5
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:MO
Practice Address - Zip Code:65084-1509
Practice Address - Country:US
Practice Address - Phone:573-378-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019044904101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional