MEDICARE: DR. THOMAS KELSEY LANE D.MIN.

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	101YP2500X	Professional Counselor	2275	NC

General Provider Information

NPI Number	:	1285846329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS KELSEY LANE D.MIN.

Provider Business Mailing Address
First Line	:	107 PINEBURR RD
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27455-1722
Country	:	US
Telephone Number	:	336-545-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	912 N ELM ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27401-1513
Country	:	US
Telephone Number	:	336-545-1200
Fax Number	:

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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