| Doctor Name: | DAVID BALLARD LANE |
| NPI Number: | 1356481014 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LMSW, LLP, LPC |
| License Number: | 6401000213 |
| Business Practice Address: | 1199 Harris Ave Tawas City, MI - 487639681 |
| Business Phone Number: | 9893628636 |
| Business Fax Number: | |
| Mailing Address: | 1635 Douglas Dr, TAWAS CITY |
| State: | MI |
| Postal Code: | 487639422 |
| Phone Number: | 9893628636 |
| Fax Number: | |
| NPI Enumeration Date: | 02/08/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 6401000213 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |