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General NPI Number Information
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NPI Number | 1053975128
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Entity Type | Individual
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Provider Name | ANNE LANE LPC
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Gender | Female
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Dates
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Enumeration Date | 04/24/2019
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Last Update Date | 11/09/2021
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Provider Practice Location Address
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Address Line | 357 N MOUNTAIN VIEW DR # 206
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City | BAYFIELD
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State | CO
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Zip | 81122-9500
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Country | US
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Telephone | 970-501-8198
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Fax |
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Provider Business Mailing Address
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Address Line | 1917 COUNTY ROAD 988
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City | IGNACIO
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State | CO
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Zip | 81137-9643
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Country | US
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Telephone | 970-501-8198
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 37504
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC.0017421
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License Number State | CO
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