Basic Information
| Provider Information | |||||||||
| NPI: | 1679914428 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DREYFUSS | ||||||||
| FirstName: | LANA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LPCC LCADC LPC HTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 155 RELLIM RD | ||||||||
| Address2: | |||||||||
| City: | CRESCENT CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955319687 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2405155122 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 501 N INDIAN RD | ||||||||
| Address2: | |||||||||
| City: | SMITH RIVER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955679509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074870215 | ||||||||
| FaxNumber: | 7074873003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2013 | ||||||||
| LastUpdateDate: | 08/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | PC008271 | PA | N | Behavioral Health & Social Service Providers | Psychologist | Counseling | 103TC1900X | LCA1586 | MD | N | Behavioral Health & Social Service Providers | Psychologist | Counseling | 103TC1900X | LPCC11223 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No ID Information.