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NPI Code Detail

MEDICARE: DAVID BALLARD LANE JR. LMSW, LLP, LPC

MEDICARE: DAVID BALLARD LANE JR. LMSW, LLP, LPC
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
1101YP2500XProfessional Counselor6401000213MI
2103T00000XPsychologist6301003884MI
31041C0700XClinical Social Worker6801016231MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
16401000213OTHERMILPC
26301003884OTHERMILLP
36801016231OTHERMILMSW

General Provider Information

NPI Number : 1356481014
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID BALLARD LANE JR. LMSW, LLP, LPC
Provider Business Mailing Address
First Line : 1635 DOUGLAS DR
Second Line :
City : TAWAS CITY
State : MI
Zip : 48763-9422
Country : US
Telephone Number : 989-362-8636
Fax Number :
Provider Business Practice Location Address
First Line : 1199 HARRIS AVE
Second Line :
City : TAWAS CITY
State : MI
Zip : 48763-9681
Country : US
Telephone Number : 989-362-8636
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2007
Last Update Date : 09/11/2025

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