Provider Demographics
NPI:1629412507
Name:LANA, TOMIKE (PSYD)
Entity type:Individual
Prefix:
First Name:TOMIKE
Middle Name:
Last Name:LANA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6160 N CICERO AVE STE 122
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-4308
Mailing Address - Country:US
Mailing Address - Phone:773-782-7229
Mailing Address - Fax:872-225-0037
Practice Address - Street 1:6160 N CICERO AVE STE 122
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4308
Practice Address - Country:US
Practice Address - Phone:773-782-7229
Practice Address - Fax:872-225-0037
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL07008479103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical