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NPI Code Detail

MEDICARE: KRISTINE LANE BS CAC III

MEDICARE: KRISTINE LANE BS CAC III
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
1101YA0400XAddiction (Substance Use Disorder) CounselorACC.0020879CO

General Provider Information

NPI Number : 1215423371
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTINE LANE BS CAC III
Provider Business Mailing Address
First Line : 5360 N ACADEMY BLVD STE 290
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80918-4038
Country : US
Telephone Number : 719-434-2061
Fax Number : 719-434-2275
Provider Business Practice Location Address
First Line : 5360 N ACADEMY BLVD STE 290
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80918-4038
Country : US
Telephone Number : 719-434-2061
Fax Number : 719-434-2275
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2018
Last Update Date : 07/02/2018

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Directions to “ KRISTINE LANE BS CAC III” Practice Location

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