Doctor Name: | STEPHANIE KRISTINE LANE |
NPI Number: | 1255498242 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 991 Parallel Dr Lakeport, CA - 954535720 |
Business Phone Number: | 7072634338 |
Business Fax Number: | 7072631507 |
Mailing Address: | 10015 El Capitan Way, KELSEYVILLE |
State: | CA |
Postal Code: | 95451 |
Phone Number: | 7072770908 |
Fax Number: | 7072770444 |
NPI Enumeration Date: | 01/02/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |