Provider Demographics
NPI:1144956756
Name:LANIER, LAELLE (MS, LPC-IT)
Entity type:Individual
Prefix:
First Name:LAELLE
Middle Name:
Last Name:LANIER
Suffix:
Gender:F
Credentials:MS, LPC-IT
Other - Prefix:
Other - First Name:LILLY
Other - Middle Name:
Other - Last Name:LANIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2400 E BRADFORD AVE APT 203
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-4165
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7280 S 13TH ST STE 202
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-1831
Practice Address - Country:US
Practice Address - Phone:262-251-1112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7014226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health