Provider Demographics
NPI:1366186140
Name:PROVINCE, BRITTANY LANE (LMSW)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:LANE
Last Name:PROVINCE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 COUNTY ROAD 1001
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-9786
Mailing Address - Country:US
Mailing Address - Phone:662-279-0454
Mailing Address - Fax:
Practice Address - Street 1:136 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-9037
Practice Address - Country:US
Practice Address - Phone:712-458-6201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM9545104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker