MEDICARE: LAURA LYN ZANE, PLLC

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	MH10694	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MH10694	OTHER	FL	LICENSED MENTAL HEALTH
2	1962779736	OTHER		INDIVIDUAL NPI

General Provider Information

NPI Number	:	1114308319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAURA LYN ZANE, PLLC

Provider Business Mailing Address
First Line	:	425 GILLESPIE AVE
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34236-4214
Country	:	US
Telephone Number	:	941-650-3122
Fax Number	:	931-552-8343

Provider Business Practice Location Address
First Line	:	2800 HILLVIEW ST
Second Line	:	SUITE 2
City	:	SARASOTA
State	:	FL
Zip	:	34239-3221
Country	:	US
Telephone Number	:	941-650-3122
Fax Number	:

Authorized Official
Title or Position	:	OWNER/COUNSELOR
Name	:	LAURA LYN ZANE-NWAGBARAOCHA
Credential	:	LMHC
Telephone Number	:	941-650-3122

Provider Enumeration Date	:	06/12/2015
Last Update Date	:	06/12/2015

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