Myia Cormichel Lane, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C11117 Issued in MS

Practice address

4605 Goldfinch Dr
Gulfport, MS 39501-7218

Phone

(228) 219-5219

NPI assigned

Jul 31, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Premier Professional Counseling Services, LLC

  • Clinical Social Worker
  • Gulfport, MS
  • NPI 1750878781
  Medicare reassignment NPD
• Kimila Deflanders LCSW LLC

  • Clinical Social Worker
  • Gulfport, MS
  • NPI 1588217699
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1690761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1831870815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "69 HOLLY CIR",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395018629",
            "telephone_number": "228-219-5219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4605 GOLDFINCH DR",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395017218",
            "telephone_number": "228-219-5219"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "69 Holly Cir",
            "address_purpose": "LOCATION",
            "city": "Gulfport",
            "state": "MS",
            "postal_code": "395018629",
            "country_code": "US",
            "telephone_number": "228-219-5219",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LANE",
        "first_name": "MYIA",
        "middle_name": "CORMICHEL",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-07-31",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MS",
            "license": "M9748",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MS",
            "license": "C11117",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danielle Landers, DPT
• Hope Landis, N.P.
• Landmark Medical of Mississippi PC
• Thomas Edward Landon Jr., N.P.
• Kianna Jeanette Lane
• Allison Laney, N.P.
• Crystal A Langlois, RD, LD
• Douglas C Lanier, M.D.
• Joseph Anthony Lanni, M.D.
• Beverly Lansden, M.D.

• Clinical Social Worker in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Clinical Social Worker in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.