Provider Demographics
NPI:1710204375
Name:DILLON, LANA JO (LPC, LPE)
Entity type:Individual
Prefix:MRS
First Name:LANA
Middle Name:JO
Last Name:DILLON
Suffix:
Gender:F
Credentials:LPC, LPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E KINGSHIGHWAY
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4537
Mailing Address - Country:US
Mailing Address - Phone:870-476-1275
Mailing Address - Fax:870-335-2350
Practice Address - Street 1:600 E KINGSHIGHWAY
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4537
Practice Address - Country:US
Practice Address - Phone:870-476-1275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-22
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR07-12E103T00000X
ARP0509062101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR172086795Medicaid