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NPI Code Detail

MEDICARE: HARLIE LANE

MEDICARE: HARLIE 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
1101YP2500XProfessional Counselor
2106H00000XMarriage & Family Therapist
31041C0700XClinical Social Worker
4101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1558043489
Entity Type Code : Individual
Provider Name (Legal Business Name) : HARLIE LANE
Provider Business Mailing Address
First Line : 1900 SILVER LAKE RD NW STE 110
Second Line :
City : NEW BRIGHTON
State : MN
Zip : 55112-1789
Country : US
Telephone Number : 651-628-9566
Fax Number : 651-628-0411
Provider Business Practice Location Address
First Line : 2680 SNELLING AVE N STE 200
Second Line :
City : ROSEVILLE
State : MN
Zip : 55113-1879
Country : US
Telephone Number : 651-364-9381
Fax Number : 651-364-0382
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2023
Last Update Date : 05/12/2026

Similar Medicare Providers

1760319974 — MICHAEL ELOY GARCIA LICSW
Practice Location Address:
2680 SNELLING AVE N STE 200
ROSEVILLE, MN
55113-1879
Practice Phone: 651-364-9381
Practice Fax: 651-364-9382
1689493249 — DR. BELLE P KHUU PHD, LICSW
Practice Location Address:
2680 SNELLING AVE N STE 200
ROSEVILLE, MN
55113-1879
Practice Phone: 651-364-9381
Practice Fax: 651-364-9382
1437113602 — CHRISTOPHER GARY FOSS MD
Practice Location Address:
2680 SNELLING AVE N STE 200
ROSEVILLE, MN
55113-1879
Practice Phone: 651-326-1600
Practice Fax:
1750748422 — MRS. LISA CHONG ROSE LPCC
Practice Location Address:
2680 SNELLING AVE N STE 200
ROSEVILLE, MN
55113-1879
Practice Phone: 651-364-9381
Practice Fax: 651-364-9382
1962959684 — JESSICA RITCHEY MA, LMFT
Practice Location Address:
2680 SNELLING AVE N STE 200
ROSEVILLE, MN
55113-1879
Practice Phone: 651-364-9381
Practice Fax: 651-364-9382
1508376732 — PATTY-JO KATHERINE MANTEL DNP
Practice Location Address:
2680 SNELLING AVE N STE 200
ROSEVILLE, MN
55113-1879
Practice Phone: 651-364-9381
Practice Fax: 651-364-9382

Directions to “ HARLIE LANE ” Practice Location

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