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General NPI Number Information
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NPI Number | 1992386957
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Entity Type | Individual
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Provider Name | LANA JANELLE DURAN LSW
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Gender | Female
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Dates
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Enumeration Date | 04/20/2021
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Last Update Date | 04/20/2021
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Provider Practice Location Address
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Address Line | 407 S FLORENCE AVE
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City | BLOOMINGTON
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State | IL
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Zip | 61701-5627
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Country | US
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Telephone | 217-828-1331
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Fax |
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Provider Business Mailing Address
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Address Line | 200 W MONROE ST STE C7
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City | BLOOMINGTON
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State | IL
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Zip | 61701-3997
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Country | US
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Telephone | 217-828-1331
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 150105053
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License Number State | IL
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