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General NPI Number Information
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NPI Number | 1770147548
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Entity Type | Organization
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Legal Business Name | MARY JANE LANE LMFT LLC
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Dates
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Enumeration Date | 04/27/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 412 S CLAY AVE # 212
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City | KIRKWOOD
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State | MO
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Zip | 63122-5860
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Country | US
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Telephone | 314-805-2977
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Fax | 314-822-9696
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Provider Business Mailing Address
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Address Line | 412 S CLAY AVE # 212
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City | KIRKWOOD
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State | MO
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Zip | 63122-5860
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Country | US
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Telephone | 314-805-2977
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Fax | 314-822-9696
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Authorized Official
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Title or Position | PROVIDER
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Name | MARY JANE LANE
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Credential | LPC LMFT
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Telephone | 314-805-2947
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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