Healthcare Provider Details

I. General information

NPI: 1407796626
Provider Name (Legal Business Name): SECOND LANE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N RIVERSIDE DR STE 215
GURNEE IL
60031-5918
US

IV. Provider business mailing address

28674 BRAELOCH CT
LAKE BLUFF IL
60044-3004
US

V. Phone/Fax

Practice location:
  • Phone: 224-208-8484
  • Fax:
Mailing address:
  • Phone: 224-208-8484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN GEORGE HIDES
Title or Position: MEMBER MANAGER
Credential:
Phone: 224-208-8484