MEDICARE: SUSAN LANE LPCC

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	101YP2500X	Professional Counselor	0088191	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578506705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN LANE LPCC

Provider Business Mailing Address
First Line	:	1306 RIO GRANDE BLVD NW
Second Line	:	SUITE B
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87104-2633
Country	:	US
Telephone Number	:	505-830-1200
Fax Number	:	505-830-1203

Provider Business Practice Location Address
First Line	:	1306 RIO GRANDE BLVD NW
Second Line	:	SUITE B
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87104-2633
Country	:	US
Telephone Number	:	505-830-1200
Fax Number	:	505-830-1203

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	12/18/2007

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Directions to “ SUSAN LANE LPCC” Practice Location

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