Healthcare Provider Details

I. General information

NPI: 1679302095
Provider Name (Legal Business Name): TAIHESIA LANE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2904 ANGELINE DR
GLENSHAW PA
15116-1549
US

IV. Provider business mailing address

2904 ANGELINE DR
GLENSHAW PA
15116-1549
US

V. Phone/Fax

Practice location:
  • Phone: 303-902-3068
  • Fax: 303-484-3943
Mailing address:
  • Phone: 303-902-3068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: