Healthcare Provider Details

I. General information

NPI: 1619573219
Provider Name (Legal Business Name): LANE COUNSELING AND COACHING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6794 RICHARD AVE
CINCINNATI OH
45224-1148
US

IV. Provider business mailing address

6794 RICHARD AVE
CINCINNATI OH
45224-1148
US

V. Phone/Fax

Practice location:
  • Phone: 513-909-2497
  • Fax:
Mailing address:
  • Phone: 513-909-2497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KELLY LANE
Title or Position: OWNER/THERAPIST
Credential: LPCC
Phone: 513-909-2497