Basic Information
Provider Information
NPI: 1700129020
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LANEY
FirstName: HILLARY
MiddleName: J
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: LIEBMAN
OtherFirstName: HILLARY
OtherMiddleName: J
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 2329 LARK ST APT B
Address2: SUITE 3
City: OAK HARBOR
State: WA
PostalCode: 982774785
CountryCode: US
TelephoneNumber: 2066970784
FaxNumber:  
Practice Location
Address1: 231 SE BARRINGTON DR
Address2: SUITE 203
City: OAK HARBOR
State: WA
PostalCode: 982773200
CountryCode: US
TelephoneNumber: 3602400022
FaxNumber: 3602400023
Other Information
ProviderEnumerationDate: 04/04/2013
LastUpdateDate: 08/07/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103K00000X  Y Behavioral Health & Social Service ProvidersBehavioral Analyst 

No ID Information.


Home