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Individual

MRS. MARY E LANHAM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
BSECE,RA

Contact information

Practice address
1083 MENTOR AVE, PAINESVILLE, OH 44077-1829
(440) 358-7370
(440) 358-7373
Mailing address
8445 MUNSON RD, MENTOR, OH 44060-2410
(440) 255-1700
(440) 255-2441

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
RA161723
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
284093
OH
Enumeration date
05/09/2019
Last updated
05/09/2019
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