MEDICARE: MARK ALAN DANE MMFT, LPC-S, LCDC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	P2502004	AR
2	101YM0800X	Mental Health Counselor	14677	TX

General Provider Information

NPI Number	:	1285107722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK ALAN DANE MMFT, LPC-S, LCDC

Provider Business Mailing Address
First Line	:	8221 RANCH BLVD STE 25
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72223-4616
Country	:	US
Telephone Number	:	714-932-7272
Fax Number	:	866-803-2188

Provider Business Practice Location Address
First Line	:	5750 GENESIS CT STE 135
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75034-4229
Country	:	US
Telephone Number	:	214-347-9778
Fax Number	:	866-803-2188

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2019
Last Update Date	:	02/18/2026

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