Healthcare Provider Details

I. General information

NPI: 1447766035
Provider Name (Legal Business Name): JENNIFER C LANE QMHS,CMS,CDCA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 SYCAMORE ST
CINCINNATI OH
45202-1318
US

IV. Provider business mailing address

911 SYCAMORE ST
CINCINNATI OH
45202-1318
US

V. Phone/Fax

Practice location:
  • Phone: 513-618-4229
  • Fax: 513-352-1348
Mailing address:
  • Phone: 513-651-9300
  • Fax: 513-352-1348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCDCA.164623
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2406649
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: