Provider Demographics
NPI:1558189662
Name:LANIER, ROMAN ANTHONY BARON
Entity type:Individual
Prefix:
First Name:ROMAN
Middle Name:ANTHONY BARON
Last Name:LANIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 KORIE CIR
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-5430
Mailing Address - Country:US
Mailing Address - Phone:405-659-8295
Mailing Address - Fax:
Practice Address - Street 1:2901 SE 22ND ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73129-8413
Practice Address - Country:US
Practice Address - Phone:405-618-0150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0313101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health