Healthcare Provider Details

I. General information

NPI: 1215848833
Provider Name (Legal Business Name): EMILY JEAN LANE MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 ELMHURST AVE
HUMBOLDT IA
50548-1882
US

IV. Provider business mailing address

1721 ELMHURST AVE
HUMBOLDT IA
50548-1882
US

V. Phone/Fax

Practice location:
  • Phone: 307-274-8705
  • Fax: 515-420-8303
Mailing address:
  • Phone: 307-274-8705
  • Fax: 515-420-8303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number140944
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: