MEDICARE: MELISSA LANE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1033208657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA LANE

Provider Business Mailing Address
First Line	:	4537 WOODLAND CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-2094
Country	:	US
Telephone Number	:	317-223-1674
Fax Number	:

Provider Business Practice Location Address
First Line	:	4537 WOODLAND CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-2094
Country	:	US
Telephone Number	:	317-223-1674
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	06/12/2014

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Directions to “ MELISSA LANE ” Practice Location

Language	Start Address	Practice Location

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